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Labouret M, Trebossen V, Ntorkou A, Bartoli S, Aubart M, Auvin S, Bader-Meunier B, Baudouin V, Corseri O, Dingulu G, Ducrocq C, Dumaine C, Elmaleh M, Fabien N, Faye A, Hau I, Hentgen V, Kwon T, Meinzer U, Ouldali N, Parmentier C, Pouletty M, Renaldo F, Savioz I, Benoist JF, Le Roux E, Ellul P, Melki I. Juvenile neuropsychiatric systemic lupus erythematosus: A specific clinical phenotype and proposal of a probability score. Lupus 2024; 33:328-339. [PMID: 38315109 DOI: 10.1177/09612033241229022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Juvenile systemic lupus erythematosus (j-SLE) is a rare chronic auto-immune disease involving several organs. Neuropsychiatric (NP) SLE (NPSLE) is frequent in j-SLE and associated with increased morbidity/mortality. Although NPSLE classification criteria exist, attributing NP features to j-SLE remains a major challenge. The study objective is to thoroughly describe j-NPSLE patients and assist in their diagnosis. METHODS This is a 4-year retrospective monocentric study of j-SLE patients. NP events were attributed to j-SLE using standardised diagnostic criteria and multidisciplinary paediatric clinical expertise. Clinical features, brain magnetic resonance imaging (MRI)s and samples analysis including cerebrospinal fluid were assessed. A risk of j-NPSLE score was developed based on multivariable logistic regression analysis. RESULTS Of 39 patients included, 44% were identified as having j-NPSLE. J-NPSLE diagnosis was established at the onset of j-SLE in 59% of patients. In addition to frequent kidney involvement (76%) and chilblains (65%), all j-NPSLE patients displayed psychiatric features: cognitive symptoms (82%), hallucinations (76%), depressed mood (35%), acute confused state (18%) and catatonia (12%). Neurological involvement was often mild and nonspecific, with headache (53%) in about half of the patients. The main features reported on brain MRI were nonspecific T2/FLAIR white matter hyperintensities (65%), and cerebral atrophy (88%). Upon immunosuppressive treatment, clinical improvement of NP features was observed in all j-NPSLE patients. The score developed to attribute j-NPSLE probability, guide further investigations and appropriate treatments is based on hallucinations, memory, sleep and renal involvement (Sensitivity: 0.95 Specificity: 0.85). Cerebrospinal fluid (CSF) neopterin assessment increases the score sensitivity and specificity. CONCLUSION Physicians should carefully and systematically assess the presence of NP features at diagnosis and early stages of j-SLE. For j-NPSLE patients with predominant psychiatric features, a multidisciplinary collaboration, including psychiatrists, is essential for the diagnosis, management and follow-up.
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Affiliation(s)
- Mathilde Labouret
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Sorbonne Université, Paris, France
| | - Vincent Trebossen
- Department of Child and Adolescent Psychiatry, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
- Université Paris Cité, UFR de Médecine Paris Nord, Paris, France
| | - Alexandra Ntorkou
- Department of Paediatric Radiology, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
| | - Sophie Bartoli
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Mélodie Aubart
- Paediatric Neurology Department, Necker-Enfants Malades Hospital, University of Paris-Cité, AP-HP, Paris, France
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, French Institute of Health and Medical Research U1163, Imagine Institute, University of Paris-Cité, Paris, France
| | - Stéphane Auvin
- Department of Paediatric Neurology, Center for Rare Epilepsies & Epilepsy Unit, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
- Université Paris Cité, INSERM NeuroDiderot, Paris, France
- Institut Universitaire de France (IUF), Paris, France
| | - Brigitte Bader-Meunier
- Department of Paediatric Haematology-Immunology And Rheumatology, Necker-Enfants-Malades University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Laboratory of Immunogenetics of Paediatric Autoimmune Diseases, Imagine Institute, INSERM UMR 1163, Université Paris Cité, Paris, France
| | - Véronique Baudouin
- Department of Paediatric Nephrology, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
| | - Olivier Corseri
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Glory Dingulu
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Camille Ducrocq
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Cécile Dumaine
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Monique Elmaleh
- Department of Paediatric Radiology, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
| | - Nicole Fabien
- Immunology Department, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Lyon, France
| | - Albert Faye
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Université Paris Cité, UFR de Médecine Paris Nord, Paris, France
- UMR1123 Inserm, Université Paris Cité, Paris, France
| | - Isabelle Hau
- Department of General Paediatrics, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Véronique Hentgen
- Department of General Paediatrics, French Reference centre for Autoinflammatory diseases and amyloidosis (CEREMAIA), Versailles Hospital, Le Chesnay, France
| | - Théresa Kwon
- Department of Paediatric Nephrology, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
| | - Ulrich Meinzer
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Université Paris Cité, UFR de Médecine Paris Nord, Paris, France
- Center for Research on Inflammation, INSERM, Université Paris Cité, Paris, France
- Biology and Genetics of Bacterial Cell Wall Unit, Pasteur Institute, Paris, France
| | - Naim Ouldali
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Université Paris Cité, UFR de Médecine Paris Nord, Paris, France
| | - Cyrielle Parmentier
- Department of Paediatric Nephrology, Armand-Trousseau Childrens' Hospital, AP-HP, Paris, France
| | - Marie Pouletty
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Florence Renaldo
- Department of Paediatric Neurology, Center for Neurogenetic Diseases, Armand-Trousseau Childrens' Hospital, AP-HP, Paris, France
| | - Isabelle Savioz
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Jean-François Benoist
- Metabolic Biochemistry Laboratory, Reference Centre for Inherited Metabolic Diseases, Necker-Enfants-Malades University Hospital, AP-HP, Paris, France
- Université Paris Saclay, UFR Pharmacie, France
| | - Enora Le Roux
- UMR1123 Inserm, Université Paris Cité, Paris, France
- Unité d'Épidémiologie Clinique, Inserm, CIC 1426, Robert Debré Mother-Child University Hospital, Nord-Université Paris Cité, AP-HP, Paris, France
| | - Pierre Ellul
- Department of Child and Adolescent Psychiatry, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
- Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, Paris, France
| | - Isabelle Melki
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Department of Paediatric Haematology-Immunology And Rheumatology, Necker-Enfants-Malades University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Imagine Institute, Laboratory of Neurogenetics and Neuroinflammation, INSERM UMR 1163, Université Paris Cité, Paris, France
- Paediatrics, Rheumatology and Paediatric Internal Medicine, Children's Hospital, Bordeaux, France
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Felix A, Assad Z, Bidet P, Caseris M, Dumaine C, Faye A, Melki I, Kaguelidou F, Valtuille Z, Ouldali N, Meinzer U. Common Seasonal Pathogens and Epidemiology of Henoch-Schönlein Purpura Among Children. JAMA Netw Open 2024; 7:e245362. [PMID: 38578638 PMCID: PMC10998156 DOI: 10.1001/jamanetworkopen.2024.5362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/08/2024] [Indexed: 04/06/2024] Open
Abstract
Importance Henoch-Schönlein purpura (HSP) is the most common type of vasculitis in children. The factors that trigger the disease are poorly understood. Although several viruses and seasonal bacterial infections have been associated with HSP, differentiating the specific associations of these pathogens with the onset of HSP remains a challenge due to their overlapping seasonal patterns. Objective To analyze the role of seasonal pathogens in the epidemiology of HSP. Design, Setting, and Participants This cohort study comprised an interrupted time-series analysis of patient records from a comprehensive national hospital-based surveillance system. Children younger than 18 years hospitalized for HSP in France between January 1, 2015, and March 31, 2023, were included. Exposure Implementation and relaxation of nonpharmaceutical interventions (NPIs) for the COVID-19 pandemic, such as social distancing and mask wearing. Main Outcomes and Measures The main outcomes were the monthly incidence of HSP per 100 000 children, analyzed via a quasi-Poisson regression model, and the estimated percentage of HSP incidence potentially associated with 14 selected common seasonal pathogens over the same period. Results The study included 9790 children with HSP (median age, 5 years [IQR, 4-8 years]; 5538 boys [56.4%]) and 757 110 children with the infectious diseases included in the study (median age, 0.7 years [IQR, 0.2-2 years]; 393 697 boys [52.0%]). The incidence of HSP decreased significantly after implementation of NPIs in March 2020 (-53.6%; 95% CI, -66.6% to -40.6%; P < .001) and increased significantly after the relaxation of NPIs in April 2021 (37.2%; 95% CI, 28.0%-46.3%; P < .001). The percentage of HSP incidence potentially associated with Streptococcus pneumoniae was 37.3% (95% CI, 22.3%-52.3%; P < .001), the percentage of cases associated with Streptococcus pyogenes was 25.6% (95% CI, 16.7%-34.4%; P < .001), and the percentage of cases associated with human rhino enterovirus was 17.1% (95% CI, 3.8%-30.4%; P = .01). Three sensitivity analyses found similar results. Conclusions and Relevance This study found that significant changes in the incidence of HSP simultaneously with major shifts in circulating pathogens after NPIs for the COVID-19 pandemic indicated that approximately 60% of HSP incidence was potentially associated with pneumococcus and group A streptococcus. This finding suggests that preventive measures against these pathogens could reduce the incidence of pediatric HSP.
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Affiliation(s)
- Arthur Felix
- Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Department of General Pediatrics, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Competence Centre RAISE Antilles-Guyane, EpiCliV Research Unit, Department of General Pediatrics, Martinique University Hospital, University of French West Indies, Martinique, France
| | - Zein Assad
- Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Department of General Pediatrics, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Infection, Antimicrobials, Modeling, Evolution, Paris Cité University, INSERM UMR 1137, Paris, France
| | - Philippe Bidet
- Infection, Antimicrobials, Modeling, Evolution, Paris Cité University, INSERM UMR 1137, Paris, France
- Department of Microbiology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marion Caseris
- Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Department of General Pediatrics, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cécile Dumaine
- Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Department of General Pediatrics, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Albert Faye
- Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Department of General Pediatrics, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, INSERM UMR-1123, ECEVE, Paris, France
| | - Isabelle Melki
- Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Department of General Pediatrics, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Pediatrics, Rheumatology and Pediatric Internal Medicine, Children’s Hospital, Bordeaux, France
| | - Florentia Kaguelidou
- Center of Clinical Investigations, INSERM CIC1426, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Zaba Valtuille
- Center of Clinical Investigations, INSERM CIC1426, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Naïm Ouldali
- Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Department of General Pediatrics, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Infection, Antimicrobials, Modeling, Evolution, Paris Cité University, INSERM UMR 1137, Paris, France
| | - Ulrich Meinzer
- Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Department of General Pediatrics, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Recherche sur l’inflammation UMR 1149, Université Paris Cité, INSERM, Paris, France
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Dusser P, Belot A, Bajolle F, Kevorkian-Verguet C, Meinzer U, Huet F, Tiriau S, Kone-paut I. Subcutaneous anakinra in the management of refractory MIS-C in France. Front Pediatr 2024; 12:1270878. [PMID: 38464895 PMCID: PMC10920278 DOI: 10.3389/fped.2024.1270878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/18/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction Multisystemic inflammatory syndrome in children (MIS-C) is a therapeutic emergency and can lead to myocardial dysfunction (17%-75%) and heart failure (52%-53%). Intravenous immunoglobulins (IVIG) and corticosteroids (CST) have been validated for the management of this condition. Recent reports suggest that an interleukin-1 (IL-1) receptor antagonist, namely anakinra, may be a valuable add-on to the 2019 novel coronavirus disease (COVID-19) treatment for refractory patients. The purpose of this study was to describe the clinico-biological characteristics of patients treated with anakinra as well as the efficacy and safety of subcutaneous anakinra therapy in this condition. Methods The prospective multicentre study of children hospitalized for MIS-C between March 2020 and September 2022, including 23 international paediatric centres, followed for a mean duration of 3.072 ± 3.508 months. The patient data were extracted from the Juvenile Inflammatory Rheumatism (JIR) cohort. The clinico-pathological characteristics, cardiac ultrasound data, and adverse events were reported in patients receiving anakinra. Results Of the 470 children admitted with MIS-C, 18 French patients (50% girls) with a mean age of 10.06 ± 3.9 years were treated with subcutaneous anakinra. Anakinra was used in two situations, macrophage activation syndrome (MAS) (4 patients) and heart failure (14 patients) with a median left ventricular ejection fraction (LVEF) of 39.5% (30%-45%). The average dose of anakinra received was 2.53 ± 1.3 mg/kg/day for a median duration of 3 days. Prior to introduction, 78% (n = 14/18) of the patients had received CST and 56% (n = 10/18) had received IVIG. Only two patients received IVIG alone and six received CST alone plus anakinra. In 10% of cases, IVIG was poorly tolerated from a cardiovascular point of view and was discontinued. Transient elevations in serum transaminases were noted in four patients on anakinra without the need for treatment or dose modification. In all patients, rapid (48 h) improvement in myocardial function was observed (LVEF > 55%) with a concomitant significant decrease in myocardial enzymes (p < 0.05). All patients survived with complete recovery of cardiac function without sequelae. Conclusions Subcutaneous anakinra appears to be a safe and effective treatment for the management of heart failure or MAS in MIS-C patients. The value of IVIG in these two situations remains to be reviewed.
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Affiliation(s)
- Perrine Dusser
- CEREMAIA, Pediatric Rheumatology, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Saclay, Le Kremlin Bicêtre, France
| | - Alexandre Belot
- Pediatric Nephrology, Rheumatology, Dermatology, Reference Centre of Inflammatory Rheumatism and Rare Autoimmune Diseases in Children (RAISE), Hôpital Femme Mère-Enfant, Hospices Civils de Lyon, Bron, France
| | - Fanny Bajolle
- Assistance Publique-Hôpitaux de Paris, M3C Department, Necker-Enfants Malades University Hospital, Université de Paris, Paris, France
| | | | - Ulrich Meinzer
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, INSERM, Centre de Recherche sur l'inflammation UMR 1149, Paris, France
| | - Frédéric Huet
- Pediatric Department, University Hospital of Dijon, Dijon, France
| | - Soizic Tiriau
- Department of Pediatrics, Hôpital Mère-Enfants, Nantes, France
| | - Isabelle Kone-paut
- CEREMAIA, Pediatric Rheumatology, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Saclay, Le Kremlin Bicêtre, France
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Lafay C, Assad Z, Ouldali N, Quoc EB, Clement A, Durand C, Fares S, Faye A, Eveillard LA, Kaguelidou F, Titah C, Valtuille Z, Vinit C, Meinzer U, Dumaine C. Increased Incidence of Pediatric Uveitis Associated with the COVID-19 Pandemic Occurring Before COVID-19 Vaccine Implementation: A Time-Series Analysis. J Pediatr 2023; 263:113682. [PMID: 37611738 DOI: 10.1016/j.jpeds.2023.113682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To examine whether the COVID-19 pandemic was associated with an increased incidence of uveitis in children. STUDY DESIGN We performed a time-series analysis of patient records from a national, hospital-based, French surveillance system. All children hospitalized for uveitis in France between January 2012 and March 2022 were included. The incidence of newly diagnosed uveitis per 100 000 children per trimester in France was analyzed by a quasi-Poisson regression. A cohort of children diagnosed with uveitis at Robert-Debré Hospital was used to compare the characteristics of uveitis after and before the onset of the pandemic. RESULTS During the study period, 2492 children were hospitalized for uveitis in France. The COVID-19 pandemic, which started in March 2020, was associated with a significant increase in the occurrence of uveitis (estimated cumulative change, 44.9%; 95% CI 11.4-78.4; P < .001). The increase in the incidence of pediatric uveitis started in October 2020, while the national immunization program targeting children aged less than 18 years began in June 2021. This increase involved all forms of uveitis, regardless of location, and clincial characteristics were similar to those diagnosed before the pandemic. CONCLUSIONS Our study evidenced a significant increase in the incidence of pediatric uveitis following the COVID-19 pandemic. This increase occurred 6 months before the implementation of the national COVID-19 vaccination program for children, suggesting that the resurgence of this rare disease is independent of COVID-19 vaccination.
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Affiliation(s)
- Céline Lafay
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Zein Assad
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Naïm Ouldali
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Bui Quoc
- Department of Ophthalmology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ana Clement
- Department of Ophthalmology, Adolph Rothschild Hospital, Paris, France
| | - Capucine Durand
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Selim Fares
- Department of Ophthalmology, Adolph Rothschild Hospital, Paris, France
| | - Albert Faye
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurye-Anne Eveillard
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Cité, INSERM, Centre de Recherche sur l'inflammation UMR 1149, Paris, France
| | - Florentia Kaguelidou
- Center of Clinical Investigations, INSERM CIC1426, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cherif Titah
- Department of Ophthalmology, Adolph Rothschild Hospital, Paris, France
| | - Zaba Valtuille
- Center of Clinical Investigations, INSERM CIC1426, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Caroline Vinit
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ulrich Meinzer
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Cité, INSERM, Centre de Recherche sur l'inflammation UMR 1149, Paris, France; Biology and Genetics of Bacterial Cell Wall Unit, Department of Microbiology, Institut Pasteur, Université de Paris, Paris, France.
| | - Cécile Dumaine
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Cité, INSERM, Centre de Recherche sur l'inflammation UMR 1149, Paris, France
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5
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Valtuille Z, Lefevre-Utile A, Ouldali N, Beyler C, Boizeau P, Dumaine C, Felix A, Assad Z, Faye A, Melki I, Kaguelidou F, Meinzer U. Calculating the fraction of Kawasaki disease potentially attributable to seasonal pathogens: a time series analysis. EClinicalMedicine 2023; 61:102078. [PMID: 37483549 PMCID: PMC10359724 DOI: 10.1016/j.eclinm.2023.102078] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Background Kawasaki disease is an acute, febrile, systemic vasculitis of children that primarily affects medium-sized blood vessels with a tropism for the coronary arteries. Although the etiological factors remain unknown, infections have been suggested as the trigger of Kawasaki disease. We sought to calculate the fraction of Kawasaki disease potentially attributable to seasonal infections. Methods This cohort study used a population-based time series analysis from the French hospitalisation database (Programme de Médicalisation des Systèmes d'Information), which includes all inpatients admitted to any public or private hospital in France. We included all children aged 0-17 years hospitalised for Kawasaki disease in France over 13 years. The monthly incidence of Kawasaki disease per 10,000 children over time was analysed by a quasi-Poisson regression model. The model accounted for seasonality by using harmonic terms (a pair of sines and cosines with 12-month periods). The circulation of eight common seasonal pathogens (adenovirus, influenza, metapneumovirus, Mycoplasma pneumoniae, norovirus, rhinovirus, rotavirus, respiratory syncytial virus, and Streptococcus pneumonia) over the same period was included in the model to analyse the fraction of Kawasaki disease potentially attributable to each pathogen. Infections were identified on the basis of polymerase chain reaction or rapid antigen testing in hospital laboratories. Findings Between Jan 1, 2007, and Dec 31, 2019, we included 10,337 children with Kawasaki disease and 442,762 children with the selected infectious diseases. In the Kawasaki disease cohort, the median age [IQR] was 2 [0-4] years, 6164 [59.6%] were boys. Adenovirus infection was potentially responsible for 24.4% [21.5-27.8] (p < 0.001) of Kawasaki diseases, Norovirus for 6.7% [1.3-11.2] (p = 0.002), and RSV 4.6% [1.2-7.8] (p = 0.022). Sensitivity analyses found similar results. Interpretation This cohort study of data from a comprehensive national hospitalisation database indicated that approximately 35% of Kawasaki diseases was potentially attributable to seasonal infections. Funding None.
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Affiliation(s)
- Zaba Valtuille
- Centre of Clinical Investigations, INSERM CIC1426, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France
| | - Alain Lefevre-Utile
- General Paediatrics and Paediatric Emergencies, Jean Verdier Hospital, Assistance Publique-Hôpitaux de Paris, F-93140 Paris, France
- U976 HIPI Unit, Saint-Louis Research Institute, Université de Paris Cité, Inserm, Paris, France
| | - Naim Ouldali
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Paediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France
- Université Paris Cité, ECEVE, UMR-1123, Paris, France
| | - Constance Beyler
- Department of Paediatric Cardiology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France
| | - Priscilla Boizeau
- Centre of Clinical Investigations, INSERM CIC1426, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France
- Université Paris Cité, ECEVE, UMR-1123, Paris, France
| | - Cécile Dumaine
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Paediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France
- Université Paris Cité, INSERM U1149, Centre de Recherche sur l’inflammation, F-75018, Paris, France
| | - Arthur Felix
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Paediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France
- Department of General Paediatrics, Competence Centre RAISE Antilles-Guyane, Martinique University Hospital, MFME. CHU de La Martinique, Fort-de France, France
| | - Zein Assad
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Paediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France
- Université Paris Cité, ECEVE, UMR-1123, Paris, France
| | - Albert Faye
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Paediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France
- Université Paris Cité, ECEVE, UMR-1123, Paris, France
| | - Isabelle Melki
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Paediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France
- Paediatrics, Rheumatology and Paediatric Internal Medicine, Children's Hospital, Bordeaux, France
| | - Florentia Kaguelidou
- Centre of Clinical Investigations, INSERM CIC1426, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France
- Université Paris Cité, ECEVE, UMR-1123, Paris, France
| | - Ulrich Meinzer
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Paediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France
- Université Paris Cité, INSERM U1149, Centre de Recherche sur l’inflammation, F-75018, Paris, France
- Institut Pasteur, Université de Paris Cité, Biology and Genetics of Bacterial Cell Wall Unit, Department of Microbiology, Paris, France
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6
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Galeotti C, Bajolle F, Belot A, Biscardi S, Bosdure E, Bourrat E, Cimaz R, Darbon R, Dusser P, Fain O, Hentgen V, Lambert V, Lefevre-Utile A, Marsaud C, Meinzer U, Morin L, Piram M, Richer O, Stephan JL, Urbina D, Kone-Paut I. French national diagnostic and care protocol for Kawasaki disease. Rev Med Interne 2023:S0248-8663(23)00647-1. [PMID: 37349225 DOI: 10.1016/j.revmed.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/04/2023] [Indexed: 06/24/2023]
Abstract
Kawasaki disease (KD) is an acute vasculitis with a particular tropism for the coronary arteries. KD mainly affects male children between 6 months and 5 years of age. The diagnosis is clinical, based on the international American Heart Association criteria. It should be systematically considered in children with a fever, either of 5 days or more, or of 3 days if all other criteria are present. It is important to note that most children present with marked irritability and may have digestive signs. Although the biological inflammatory response is not specific, it is of great value for the diagnosis. Because of the difficulty of recognising incomplete or atypical forms of KD, and the need for urgent treatment, the child should be referred to a paediatric hospital as soon as the diagnosis is suspected. In the event of signs of heart failure (pallor, tachycardia, polypnea, sweating, hepatomegaly, unstable blood pressure), medical transfer to an intensive care unit (ICU) is essential. The standard treatment is an infusion of IVIG combined with aspirin (before 10 days of fever, and for a minimum of 6 weeks), which reduces the risk of coronary aneurysms. In case of coronary involvement, antiplatelet therapy can be maintained for life. In case of a giant aneurysm, anticoagulant treatment is added to the antiplatelet agent. The prognosis of KD is generally good and most children recover without sequelae. The prognosis in children with initial coronary involvement depends on the progression of the cardiac anomalies, which are monitored during careful specialised cardiological follow-up.
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Affiliation(s)
- C Galeotti
- Service de rhumatologie pédiatrique, centre de référence des maladies auto-inflammatoires rares et des amyloses, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France.
| | - F Bajolle
- M3C-Necker-Enfants-Malades, hôpital Necker-Enfants-Malades, université de Paris Cité, Paris, France
| | - A Belot
- Service de néphrologie, rhumatologie et dermatologie pédiatriques, centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant (RAISE), hôpital Femme-Mère-Enfant, hospices civils de Lyon, Lyon, France
| | - S Biscardi
- Service des urgences pédiatriques, centre hospitalier intercommunal de Créteil, Créteil, France
| | - E Bosdure
- Service de spécialités pédiatriques et médecine infantile, CHU Timone-Enfants, 13385 Marseille cedex 5, France
| | - E Bourrat
- Service de pédiatrie générale, maladies infectieuses et médecine interne, centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant, hôpital universitaire Robert-Debré, université hospital, Assistance publique-Hôpitaux de Paris, 75019 Paris, France
| | - R Cimaz
- Pediatric Rheumatology Unit, Gaetano Pini Hospital, Department of Clinical Sciences and Community Health, Research Centre for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - R Darbon
- Association France vascularites, Blaisy-Bas, France
| | - P Dusser
- Service de rhumatologie pédiatrique, centre de référence des maladies auto-inflammatoires rares et des amyloses, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - O Fain
- Service de médecine interne, hôpital Saint-Antoine, Sorbonne université, AP-HP, 75012 Paris, France
| | - V Hentgen
- Service de pédiatrie, centre de référence des maladies auto-inflammatoires et de l'amylose (CEREMAIA), centre hospitalier de Versailles, Le Chesnay, France
| | - V Lambert
- Service de radiologie pédiatrique, Institut mutualiste Montsouris, CHU de Bicêtre, Le Kremlin-Bicêtre, France
| | - A Lefevre-Utile
- Service de pédiatrie générale et des urgences pédiatriques, hôpital Jean-Verdier, Assistance publique-Hôpitaux de Paris (AP-HP), Bondy, France
| | - C Marsaud
- Service de rhumatologie pédiatrique, centre de référence des maladies auto-inflammatoires rares et des amyloses, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - U Meinzer
- Service de pédiatrie générale, maladies infectieuses et médecine interne, centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant, hôpital universitaire Robert-Debré, université hospital, Assistance publique-Hôpitaux de Paris, 75019 Paris, France
| | - L Morin
- Service de réanimation pédiatrique et néonatale, DMU 3 santé de l'enfant et adolescent, hôpital Bicêtre, université Paris-Saclay, AP-HP, Le Kremlin-Bicêtre, France
| | - M Piram
- Division of Dermatology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montréal, Quebec, Canada
| | - O Richer
- Service des urgences pédiatriques, hôpital universitaire de Pellegrin, Bordeaux, France
| | - J-L Stephan
- Service de pédiatrie, CHU Saint-Étienne, Saint-Étienne, France
| | - D Urbina
- Service d'accueil des urgences pédiatriques, hôpital Nord, AP-HM, 13005 Marseille, France
| | - I Kone-Paut
- Service de rhumatologie pédiatrique, centre de référence des maladies auto-inflammatoires rares et des amyloses, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
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7
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Kechiche R, Borocco C, Bajolle F, Belot A, Poignant S, Lachaume N, Percheron L, Meinzer U, Mertes C, Despert V, Morin L, Lambert V, Dusser P, Matsa N, Hentgen V, Kone-Paut I, Galeotti C. Multisystem inflammatory syndrome in children during the COVID-19 waves: data from the Juvenile Inflammatory Rheumatism cohort. Front Pediatr 2023; 11:1126985. [PMID: 37292378 PMCID: PMC10246474 DOI: 10.3389/fped.2023.1126985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 04/17/2023] [Indexed: 06/10/2023] Open
Abstract
Introduction Multisystem inflammatory syndrome in children (MIS-C) is a new condition that first appeared in children and adolescents during the COVID-19 pandemic. We aimed to describe the diagnostic course, clinical and biological manifestations, and treatment of MIS-C during the first three COVID-19 waves. Methods We extracted patient data from the Juvenile Inflammatory Rheumatism (JIR) cohort. We analyzed data for patients meeting the World Health Organization diagnostic criteria for MIS-C from the start of the COVID-19 pandemic from March 2020 to June 30, 2021. We then compared data for patients in wave one to those in waves two and three. Results We identified 136 patients with MIS-C. The median age decreased but not significantly during the waves, from 9.9 years to 7.3 years (p = 0.105). Boys represented 52.2% (n = 71) of patients, and 46% (n = 41) of patients originated from sub-Saharan Africa (p < 0.001). Patients presented less diarrhea (p = 0.004), respiratory distress (p < 0.001), and myocarditis (p < 0.001) with progressive waves. Biological inflammation also decreased, namely, C-reactive protein level (p < 0.001), neutrophil count (p = 0.004), and albumin level (p < 0.001). Patients received more corticosteroids (p < 0.001) and required less ventilation support (p < 0.01) and less inotrope treatment (p < 0.001) in the later waves. The duration of hospitalization gradually decreased (p < 0.001), as did critical care unit admissions (p = 0.002). Conclusion Over the three COVID-19 waves, with a change in the management of MIS-C, children in the JIR cohort in France showed a less severe disease course, in particular, a greater use of corticosteroids. This observation may reflect the impact of both improved management and different SARS-CoV-2 variant.
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Affiliation(s)
- Robin Kechiche
- Department of Pediatric Rheumatology, Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Charlotte Borocco
- Department of Pediatric Rheumatology, Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Fanny Bajolle
- Department of Pediatric Cardiology, M3C-Necker, Necker-Enfants Malades Hospital, AP-HP, Paris Cité University, Paris, France
| | - Alexandre Belot
- Department of Pediatric Nephrology, Rheumatology, Dermatology, Reference Centre of Inflammatory Rheumatism and Rare Autoimmune Diseases in Children (RAISE), Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France
| | - Sylvaine Poignant
- Department of Pediatrics, Nantes University Hospital, Nantes, France
| | - Noémie Lachaume
- Department of Pediatrics, Louis Mourier University Hospital, AP-HP, Paris-Cité University, Colombe, France
| | - Lucas Percheron
- Pediatrics—Nephrology, Internal Medicine and Hypertension, Children Hospital—Toulouse University Hospital, Toulouse, France
| | - Ulrich Meinzer
- Department of General Pediatrics, Pediatric Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Clara Mertes
- Department of Pediatrics, Strasbourg University Hospital, Strasbourg, France
| | - Véronique Despert
- Department of Pediatrics, Rennes University Hospital, Rennes, France
| | - Luc Morin
- Pediatric Intensive Care Unit, Bicêtre University Hospital, AP-HP, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Virginie Lambert
- Department of Pediatric Radiology, Bicêtre University Hospital, AP-HP, Paris-Saclay University, Le Kremlin-Bicêtre, France
- Pediatric Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Perrine Dusser
- Department of Pediatric Rheumatology, Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Nassima Matsa
- Department of Pediatric Rheumatology, Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Véronique Hentgen
- Department of Pediatrics, Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), Versailles Hospital, Versailles, France
| | - Isabelle Kone-Paut
- Department of Pediatric Rheumatology, Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Caroline Galeotti
- Department of Pediatric Rheumatology, Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris-Saclay University, Le Kremlin-Bicêtre, France
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8
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Labouret M, Meinzer U, Viennois É. [Gut microbiota and miRNA: A couple of star actors in idiopathic juvenile arthritis?]. Med Sci (Paris) 2023; 39:437-444. [PMID: 37219348 DOI: 10.1051/medsci/2023065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Affiliation(s)
- Mathilde Labouret
- Inserm, U1149, Centre de recherche sur l'inflammation, Université Paris-Cité, 75018 Paris, France - Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant (RAISE), Service de pédiatrie générale, maladies infectieuses et médecine interne pédiatrique, Hôpital Robert-Debré, AP-HP, Paris, France
| | - Ulrich Meinzer
- Inserm, U1149, Centre de recherche sur l'inflammation, Université Paris-Cité, 75018 Paris, France - Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant (RAISE), Service de pédiatrie générale, maladies infectieuses et médecine interne pédiatrique, Hôpital Robert-Debré, AP-HP, Paris, France
| | - Émilie Viennois
- Inserm, U1149, Centre de recherche sur l'inflammation, Université Paris-Cité, 75018 Paris, France
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9
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Ellul P, Melki I, Antoun S, Lavialle L, Acquaviva E, Aeschlimann FA, Bader-Meunier B, Belot A, Dingulu G, Dumaine C, Faye A, Frémond ML, Meinzer U, Peyre H, Quartier P, Rosenzwajg M, Savioz I, Vinit C, Tchitchek N, Klatzmann D, Delorme R. Early systemic inflammation induces neurodevelopmental disorders: results from ARTEMIS, a French multicenter study of juvenile rheumatisms and systemic autoimmune and auto-inflammatory disorders and meta-analysis. Mol Psychiatry 2023; 28:1516-1526. [PMID: 36747095 DOI: 10.1038/s41380-023-01980-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 02/08/2023]
Abstract
Prenatal immune-mediated events are known risk factors for neurodevelopmental disorders in the offspring (NDD). Although the brain continues to develop for years after birth and many postnatal factors alter the regular trajectory of neurodevelopment, little is known about the impact of postnatal immune factors. To fill this gap we set up ARTEMIS, a cohort of juvenile rheumatisms and systemic autoimmune and auto-inflammatory disorders (jRSAID), and assessed their neurodevelopment. We then complemented our results with a systematic review and meta-analysis. In ARTEMIS, we used unsupervised and supervised analysis to determine the influence of jRSAID age at onset (AO) and delay in introduction of disease-modifying therapy (DMT) on NDD (NCT04814862). For the meta-analysis, we searched MEDLINE, EMBASE, PsycINFO, Cochrane, and Web of Science up to April 2022 without any restrictions on language, or article type for studies investigating the co-occurence of jRSAID and NDD (PROSPERO- CRD42020150346). 195 patients were included in ARTEMIS. Classification tree isolated 3 groups of patients (i) A low-risk group (AO > 130 months (m)) with 5% of NDD (ii) A medium-risk group (AO < 130 m and DMT < 2 m) with 20% of NDD (iii) and a high-risk-group (AO < 130 m and DMT > 2 m) with almost half of NDD. For the meta-analysis, 18 studies encompassing a total of (i) 46,267 children with jRSAID; 213,930 children with NDD, and 6,213,778 children as controls were included. We found a positive association between jRSAID and NDD with an OR = 1.44 [95% CI 1.31; 1.57] p < 0.0001, [I2 = 66%, Tau2 = 0.0067, p < 0.01]. Several sensitivity analyses were performed without changing the results. Metaregression confirmed the importance of AO (p = 0.005). Our study supports the association between jRSAID and NDD. AO and DMT have pivotal roles in the risk of developing NDD. We plead for systematic screening of NDD in jRSAID to prevent the functional impact of NDD.
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Affiliation(s)
- Pierre Ellul
- Excellence Centre for Autism & Neuro-developmental Disorders, Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, Paris Cité University, Paris, France. .,Inflammation-Immunopathology-Biotherapy Department (i2B), AP-HP, Pitié-Salpêtrière Hospital, Paris, and Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, INSERM, Paris, France. .,Reference Center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France.
| | - Isabelle Melki
- Reference Center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France.,General Pediatrics, Infectious Disease and Internal Medicine Department, Hôpital Robert Debre, AP-HP, Paris Cité University Paris, Paris, France.,Université Paris Cité, Inserm UMR 1163, Imagine Institute, Laboratory of Neurogenetics and Neuroinflammation, Paris, France.,Pediatric Hematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, AP-HP, Paris Cité University, Paris, France
| | - Stephanie Antoun
- Excellence Centre for Autism & Neuro-developmental Disorders, Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, Paris Cité University, Paris, France
| | - Laura Lavialle
- Excellence Centre for Autism & Neuro-developmental Disorders, Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, Paris Cité University, Paris, France
| | - Eric Acquaviva
- Excellence Centre for Autism & Neuro-developmental Disorders, Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, Paris Cité University, Paris, France
| | - Florence A Aeschlimann
- Reference Center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France.,Pediatric Hematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, AP-HP, Paris Cité University, Paris, France
| | - Brigitte Bader-Meunier
- Reference Center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France.,Pediatric Hematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, AP-HP, Paris Cité University, Paris, France
| | - Alexandre Belot
- Pediatric Nephrology, Rheumatology, Dermatology Department, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 Bd Pinel, 68677, Lyon, Bron Cedex, France
| | - Glory Dingulu
- Reference Center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France.,General Pediatrics, Infectious Disease and Internal Medicine Department, Hôpital Robert Debre, AP-HP, Paris Cité University Paris, Paris, France
| | - Cecile Dumaine
- Reference Center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France.,General Pediatrics, Infectious Disease and Internal Medicine Department, Hôpital Robert Debre, AP-HP, Paris Cité University Paris, Paris, France
| | - Albert Faye
- Reference Center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France.,General Pediatrics, Infectious Disease and Internal Medicine Department, Hôpital Robert Debre, AP-HP, Paris Cité University Paris, Paris, France
| | - Marie-Louise Frémond
- Reference Center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France.,Université Paris Cité, Inserm UMR 1163, Imagine Institute, Laboratory of Neurogenetics and Neuroinflammation, Paris, France.,Pediatric Hematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, AP-HP, Paris Cité University, Paris, France
| | - Ulrich Meinzer
- Reference Center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France.,General Pediatrics, Infectious Disease and Internal Medicine Department, Hôpital Robert Debre, AP-HP, Paris Cité University Paris, Paris, France
| | - Hugo Peyre
- Excellence Centre for Autism & Neuro-developmental Disorders, Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, Paris Cité University, Paris, France
| | - Pierre Quartier
- Reference Center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France.,Pediatric Hematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, AP-HP, Paris Cité University, Paris, France
| | - Michelle Rosenzwajg
- Inflammation-Immunopathology-Biotherapy Department (i2B), AP-HP, Pitié-Salpêtrière Hospital, Paris, and Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, INSERM, Paris, France
| | - Isabelle Savioz
- Reference Center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France.,General Pediatrics, Infectious Disease and Internal Medicine Department, Hôpital Robert Debre, AP-HP, Paris Cité University Paris, Paris, France
| | - Caroline Vinit
- Reference Center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France.,General Pediatrics, Infectious Disease and Internal Medicine Department, Hôpital Robert Debre, AP-HP, Paris Cité University Paris, Paris, France
| | - Nicolas Tchitchek
- Inflammation-Immunopathology-Biotherapy Department (i2B), AP-HP, Pitié-Salpêtrière Hospital, Paris, and Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, INSERM, Paris, France
| | - David Klatzmann
- Inflammation-Immunopathology-Biotherapy Department (i2B), AP-HP, Pitié-Salpêtrière Hospital, Paris, and Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, INSERM, Paris, France
| | - Richard Delorme
- Excellence Centre for Autism & Neuro-developmental Disorders, Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, Paris Cité University, Paris, France.,Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
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10
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Eveillard LA, Quartier P, Ouldali N, Bader-Meunier B, Aeschlimann F, Abasq C, Ballot C, Bouric P, Desdoits A, Dumaine C, Galeotti C, Hentgen V, Lefevre-Utile A, Chausset A, Hubiche T, Kupfer-Bessaguet I, Leclerq-Mercier S, Mallet S, Melki I, Merlin E, Miquel J, Piram M, Talmud D, Garcelon N, Vinit C, Welfringer A, Bourrat E, Meinzer U. Association of atypical skin manifestations at the onset of systemic juvenile idiopathic arthritis with difficult-to-treat disease: A retrospective multicenter study. J Am Acad Dermatol 2022; 87:1425-1428. [PMID: 35963289 DOI: 10.1016/j.jaad.2022.07.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 07/09/2022] [Accepted: 07/15/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Laurye-Anne Eveillard
- General Pediatrics, Department of Infectious Disease and Internal Medicine, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE) Robert Debré University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France; Centre de Recherche sur l'Inflammation, INSERM, UMR 1149, Université Paris Cité, Paris, France
| | - Pierre Quartier
- Pediatric Immunology-Hematology and Rheumatology Unit, Rare Disease Reference Centre (RAISE), IMAGINE Institute, Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Naim Ouldali
- General Pediatrics, Department of Infectious Disease and Internal Medicine, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE) Robert Debré University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Brigitte Bader-Meunier
- Pediatric Immunology-Hematology and Rheumatology Unit, Rare Disease Reference Centre (RAISE), IMAGINE Institute, Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Florence Aeschlimann
- Pediatric Immunology-Hematology and Rheumatology Unit, Rare Disease Reference Centre (RAISE), IMAGINE Institute, Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Claire Abasq
- Department of Dermatology, Brest University Hospital, Brest, France
| | - Claire Ballot
- Pediatric hematology, Jean-Minjoz Hospital, Besançon, France
| | - Pauline Bouric
- CH Auray-Vannes, Hôpital Bretagne Atlantique, Paediatric Department, Boulevard du Général Guillaudot, Vannes Cedex, France
| | - Alexandra Desdoits
- Department of Pediatric Surgery, CHU de Caen, AutoImmune and Systemic Diseases in Children (RAISE), Reference Centre for Autoinflammatory Disorders (CEREMAI), Caen, France
| | - Cécile Dumaine
- General Pediatrics, Department of Infectious Disease and Internal Medicine, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE) Robert Debré University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Caroline Galeotti
- Department of Pediatric Rheumatology, Reference Centre for Autoinflammatory diseases and amyloidosis (CEREMAIA), Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Véronique Hentgen
- Reference Centre for Autoinflammatory Disorders (CEREMAI) Centre Hospitalier de Versailles, Le Chesnay Cedex, France
| | - Alain Lefevre-Utile
- Université de Paris, INSERM, U976 HIPI Unit, Institut de Recherche Saint-Louis, Paris, France; Assistance Puplique-Hôpitaux de Paris (APHP), General Pediatrics and Pediatric Emergency Department, Jean Verdier Hospital, Bondy, France
| | - Aurélie Chausset
- Department of Pediatrics, Clermont Ferrand University Hospital, Clermont-Ferrand, France; CRECHE Unit, INSERM, CIC 1405, Clermont Auvergne University, Clermont-Ferrand, France
| | - Thomas Hubiche
- Department of Dermatology, Université Côte d'Azur, Nice, France
| | | | - Stéphanie Leclerq-Mercier
- Pathology Department, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Isabelle Melki
- General Pediatrics, Department of Infectious Disease and Internal Medicine, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE) Robert Debré University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Etienne Merlin
- Department of Pediatrics, Clermont Ferrand University Hospital, Clermont-Ferrand, France; CRECHE Unit, INSERM, CIC 1405, Clermont Auvergne University, Clermont-Ferrand, France
| | - Juliette Miquel
- Department of Pediatrics, CHU Reunion Saint-Pierre, Reunion Island, France
| | - Maryam Piram
- Department of Pediatrics, Pediatric Dermatology Unit, CHI Sainte Justine, CHU Sainte Justine Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Deborah Talmud
- Pediatric Department, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Nicolas Garcelon
- Institut Imagine, Centre de Recherche des Cordeliers, Equipe 22, UMR 1138, INSERM, Paris, France
| | - Caroline Vinit
- General Pediatrics, Department of Infectious Disease and Internal Medicine, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE) Robert Debré University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Anne Welfringer
- Department of Dermatology, Reference Centre for Genodermatoses and Rare Skin Disease (MAGEC), Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Emmanuelle Bourrat
- Department of Dermatology, Robert Debré University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Ulrich Meinzer
- General Pediatrics, Department of Infectious Disease and Internal Medicine, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE) Robert Debré University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France; Centre de Recherche sur l'Inflammation, INSERM, UMR 1149, Université Paris Cité, Paris, France.
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11
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Ouldali N, Dellepiane RM, Torreggiani S, Mauri L, Beaujour G, Beyler C, Cucchetti M, Dumaine C, La Vecchia A, Melki I, Stracquadaino R, Vinit C, Cimaz R, Meinzer U. Development of a score for early identification of children with Kawasaki disease requiring second-line treatment in multi-ethnic populations in Europe: A multicentre retrospective cohort study. Lancet Reg Health Eur 2022; 22:100481. [PMID: 35982834 PMCID: PMC9379661 DOI: 10.1016/j.lanepe.2022.100481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Early identification of high-risk patients is essential to stratify treatment algorithms of Kawasaki disease (KD) and to appropriately select patients at risk for complicated disease who would benefit from intensified first-line treatment. Several scores have been developed and validated in Asian populations but have shown low sensitivity in predicting intravenous immunoglobulin (IVIG) resistance in non-Asian populations. We sought methods to predict the need for secondary treatment after initial IVIG in non-Asian populations. Methods We conducted a retrospective, multicenter study including consecutive patients with KD admitted to two tertiary pediatric hospitals in France and Italy from 2005 to 2019. We evaluated the performance of the Kawanet-score and compared it with the performances of initial echocardiography findings, and of a newly proposed score combining the Kawanet-score and initial echocardiography findings. For each score, we assessed the AUC, sensitivity and specificity for predicting the need for second-line treatment. Findings We included 363 children with KD, 186 from France and 177 from Italy, of whom 57 (16%) required second-line therapy after the first IVIG dose. The Kawanet score, coronary artery dilation or aneurysm with maximal Z-score ≥2.0 at baseline, and abnormal initial echocardiography had a sensitivity of 43%, 55% and 65% and a specificity of 73%, 78%, 73%, respectively, for predicting the need for second-line treatment. The Kawanet-score was significantly improved by combining it with initial echocardiography findings. The best predictive performance (Sensitivity 76%, Specificity 54%) was obtained by combining the Kawanet-score with abnormal initial echocardiography, defined by the presence of either coronary artery maximal Z-score ≥2.0, pericarditis, myocarditis and/or ventricular dysfunction. This score predicted the need for second-line treatment in European, African/Afro-Caribbean and Asian ethnicity with a sensitivity of 80%, 65% and 100%, respectively, and a specificity of 56%, 51% and 61%, respectively. Interpretation Our study proposes a score that we named the Kawanet-echo score, which allows early identification of children with KD who require a second-line treatment in multi-ethnic populations in Europe. Funding None.
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12
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Kechiche R, Schvartz A, Bajolle F, Poignant S, Basmaci R, Pajot C, Meinzer U, Morin L, Lambert V, Dusser P, Matsa N, Hofer M, Koné-Paut I, Caroline G. POS1326 PIMS THROUGH THE WAVES OF COVID 19: DATA FROM THE JIR COHORT. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPaediatric inflammatory multisystem Syndrome (PIMS) is a new systemic inflammatory disease linked to SARS-CoV2 that affects children. It was first reported in may 2020 [1-2].ObjectivesThe objectives of this study were to describe patients with PIMS through the international JIR cohort registry and to compare the different profiles and treatments of these patients over the different waves.MethodsStudy patients with international PIMS criteria were included from March 2020 to June 2021. Patients were identified in the JIR cohort, an international registry collecting demographic, clinical and paraclinical data on patients with pediatric inflammatory diseases. Two groups were distinguished: from March 2020 to July 2020 for patients in the first wave, from July 2020 to June 2021 for patients in the 2nd and 3rd waves. These two groups were compared using a Fischer test for categorical data and a Mann-Whitney test for quantitative dataResults136 patients meeting the PIMS criteria were included (64 patients in the 1st wave, 72 patients after). Patients had less frequent myocarditis (51 patients in wave 1 vs. 36 patients after, p=0,0003) and respiratory distress (34 patients vs 10 patients, p<0,0001). Corticosteroids were used more frequently in the second wave (32 patients in wave 1 vs. 67 patients after July 2020, p<0,0001). Intravenous immunoglobulins were used as much over the waves (58 patients in wave 1 vs 68 patients after, p=0.5). Antibiotics were less used since the second wave (53 patients received antibiotics before July 2020 vs 11 after, p<0,0001). The duration of hospitalization decreased significantly (p<0,0001) with a median duration of 9 days during the first wave (interquartile range, 7-12) and 7 days (interquartile range, 5-10) after the first wave.ConclusionThere was a decrease in the number of complications of PIMS, particularly cardiac and respiratory complications, and a decrease in the length of hospitalization over time. The treatment of PIMS has also evolved, with a clear increase in the use of corticosteroids and a decrease in the use of antibiotics.References[1]Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P (2020) Hyperinflammatory shock in children during COVID-19 pandemic. Lancet 395:1607–1608.[2]Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M, Bonanomi E, D’Antiga L (2020) An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 395:1771–1778AcknowledgementsAcknowldgements to the French Covid-19 Paediatric Inflammation Consortium.Disclosure of InterestsNone declared
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13
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Nathan N, Montagne ME, Macchi O, Rosental PA, Chauveau S, Jeny F, Sesé L, Abou Taam R, Brocvielle M, Brouard J, Catinon M, Chapelon-Abric C, Cohen-Aubart F, Delacourt C, Delestrain C, Deschildre A, Dossier A, Epaud R, Haroche J, Houdouin V, Israel-Biet D, Juvin K, Le Jeune S, Lionnet F, Meinzer U, Mittaine M, Nunes H, Mattioni S, Naccache JM, Odièvre MH, Vincent M, Clement A, Valeyre D, Cavalin C. Exposure to inorganic particles in paediatric sarcoidosis: the PEDIASARC study. Thorax 2021; 77:404-407. [PMID: 34675126 DOI: 10.1136/thoraxjnl-2021-217870] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 09/25/2021] [Indexed: 11/04/2022]
Abstract
Inorganic antigens may contribute to paediatric sarcoidosis. Thirty-six patients matched with 36 healthy controls as well as a group of 21 sickle-cell disease (SCD) controls answered an environmental questionnaire. Patients' indirect exposure to inorganic particles, through coresidents' occupations, was higher than in healthy and SCD controls (median score: 2.5 (0.5-7) vs 0.5 (0-2), p=0.003 and 1 (0-2), p=0.012, respectively), especially for construction, exposures to metal dust, talc, abrasive reagents and scouring products. Wood or fossil energies heating were also linked to paediatric sarcoidosis. This study supports a link between mineral environmental exposure due to adult coresident occupations and paediatric sarcoidosis.
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Affiliation(s)
- Nadia Nathan
- Pediatric Pulmonology Department and Reference Center for Rare Lung Diseases RespiRare, Inserm UMR_S933 Laboratory of Childhood Genetic Diseases, Armand Trousseau Hospital, AP-HP. Sorbonne Université, Paris, France
| | - Marie-Emeline Montagne
- Pediatric Pulmonology Department and Reference Center for Rare Lung Diseases RespiRare, Armand Trousseau Hospital, AP-HP. Sorbonne Université, Paris, France
| | - Odile Macchi
- Observatoire, Samu Social de Paris, Paris, France
| | | | - Simon Chauveau
- Pulmonology Department and Inserm UMR 127, Avicenne Hospital, APHP. Université Sorbonne Paris Nord, Paris, France
| | - Florence Jeny
- Pulmonology Department and Inserm UMR 127, Avicenne Hospital, APHP. Université Sorbonne Paris Nord, Paris, France
| | - Lucile Sesé
- Pulmonology Department and Inserm UMR 127, Avicenne Hospital, APHP. Université Sorbonne Paris Nord, Paris, France
| | - Rola Abou Taam
- Pediatric Pulmonology Department and Reference Center for Rare Lung Diseases RespiRare, Necker Enfants Malades Hospital, AP-HP. Centre - Université de Paris, Paris, France
| | | | | | | | - Catherine Chapelon-Abric
- Department of Internal Medicine and Clinical Immunology, La Pitié-Salpêtrière Hospital, APHP. Sorbonne Université, Paris, France
| | - Fleur Cohen-Aubart
- Department of Internal Medicine 2, La Pitié-Salpêtrière Hospital, e3m Institute, Reference Center for Rare Systemic Diseases, Lupus, Anti-Phospholipids Syndrome, AP-HP. Sorbonne Université, Paris, France
| | - Christophe Delacourt
- Pediatric Pulmonology Department and Reference Center for Rare Lung Diseases RespiRare, Necker Enfants Malades Hospital, AP-HP. Centre - Université de Paris, Paris, France
| | - Céline Delestrain
- Pediatric Department and Reference Center for Rare Lung Diseases RespiRare, INSERM, IMRB, Centre Hospitalier Intercommunal de Créteil, Université Paris Est Creteil, Paris, France
| | - Antoine Deschildre
- Pediatric pulmonology and allergy department, Hôpital Jeanne de Flandre, Université de Lille, Lille, France
| | - Antoine Dossier
- Department of Internal Medicine, Bichat Hospital, AP-HP. Nord - Université de Paris, Paris, France
| | - Ralph Epaud
- Centre Hospitalier Intercommunal de Créteil, Pediatric Department and Reference center for rare lung diseases (RespiRare), INSERM, IMRB, Université Paris Est Creteil, Paris, France
| | - Julien Haroche
- Department of Internal Medicine 2, La Pitié-Salpêtrière Hospital, e3m Institute, Reference Center for Rare Systemic Diseases, Lupus, Anti-Phospholipids Syndrome, AP-HP. Sorbonne Université, Paris, France
| | - Véronique Houdouin
- Pediatric Pulmonology department, Robert Debré Hospital, AP-HP. Nord - Université de Paris, Paris, France
| | - Dominique Israel-Biet
- Pulmonology department, Georges Pompidou Hospital, AP-HP. Centre - Université de Paris, Paris, France
| | - Karine Juvin
- Pulmonology department, Georges Pompidou Hospital, AP-HP. Centre - Université de Paris, Paris, France
| | - Sylvain Le Jeune
- Department of Internal Medicine, Avicenne Hospital, APHP. Université Sorbonne Paris Nord, Paris, France
| | - Francois Lionnet
- Department of Internal Medicine, Tenon Hospital, AP-HP. Sorbonne Université, Paris, France
| | - Ulrich Meinzer
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Referee Center for Rare Pediatric Inflammatory Rheumatisms and Systemic Auto-Immune Diseases RAISE, Robert Debré Hospital, AP-HP. Nord - Université de Paris, Paris, France
| | - Marie Mittaine
- Pediatric Pulmonology Department, Children Hospital, CHU Toulouse, Toulouse, France
| | - Hilario Nunes
- Pulmonology Department and Inserm UMR 127, Avicenne Hospital, APHP. Université Sorbonne Paris Nord, Paris, France
| | - Sarah Mattioni
- Department of Internal Medicine, Tenon Hospital, AP-HP. Sorbonne Université, Paris, France
| | - Jean-Marc Naccache
- Pulmonology Department, Groupe hospitalier Paris Saint-Joseph and Hôpital Foch, Paris, France
| | - Marie-Hélène Odièvre
- Department of Pediatrics and Sickle Cell Disease Center, Armand Trousseau Hospital, AP-HP. Sorbonne Université, Paris, France
| | | | - Annick Clement
- Pediatric Pulmonology Department and Reference Center for Rare Lung Diseases RespiRare, Inserm UMR_S933 Laboratory of Childhood Genetic Diseases, Armand Trousseau Hospital, AP-HP. Sorbonne Université, Paris, France
| | - Dominique Valeyre
- Pulmonology Department and Inserm UMR 127, Avicenne Hospital, APHP. Université Sorbonne Paris Nord, Paris, France.,Pulmonology department, Paris Saint Joseph Hospital Group, Paris, France
| | - Catherine Cavalin
- Institut de recherche interdisciplinaire en sciences sociales (IRISSO, UMR CNRS-INRA 7170-1427), Université Paris Dauphine, PSL, Paris, France.,Laboratoire interdisciplinaire d'évaluation des politiques publiques (LIEPP), Sciences Po, Paris, France.,Centre d'études de l'emploi et du travail (CEET, CNAM), CNAM, Paris, France
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14
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Bader-Meunier B, Martins AL, Charbit-Henrion F, Meinzer U, Belot A, Cuisset L, Faye A, Georgin-Lavialle S, Quartier P, Remy-Piccolo V, Ruemmele F, Uettwiller F, Viala J, Cerf Bensussan N, Berrebi D, Melki I. Mevalonate Kinase Deficiency: A Cause of Severe Very-Early-Onset Inflammatory Bowel Disease. Inflamm Bowel Dis 2021; 27:1853-1857. [PMID: 34525209 DOI: 10.1093/ibd/izab139] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Indexed: 12/20/2022]
Abstract
Mevalonate kinase deficiency should be considered in patients with severe very-early-onset inflammatory bowel disease (IBD), especially in patients with a history of recurrent or chronic fever, peritoneal adhesions, and atypical IBD pathology. Anti-interleukin-1 therapy may be efficacious in these patients with monogenic very-early-onset IBD.
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Affiliation(s)
- Brigitte Bader-Meunier
- Department of Paediatric Immunology, Hematology, and Rheumatology, Groupe Hospitalier Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Reference Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Assistance Publique-Hôpitaux de Paris, and Imagine Foundation, Paris, France
| | - Andreia Luís Martins
- Pediatric Department, Professor Doutor Fernando Fonseca Hospital, Amadora, Portugal
| | - Fabienne Charbit-Henrion
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Groupe Hospitalier Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France.,Laboratory of Intestinal Immunity, Imagine Institute, Paris, France
| | - Ulrich Meinzer
- Université de Paris, Paris, France.,Department of General Paediatric, Infectious Diseases and Internal Medicine, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, Reference Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Assistance Publique-Hôpitaux de Paris, Paris, France.,Center for Research on Inflammation, Paris, France.,Biology and Genetics of Bacterial Cell Wall Unit, Pasteur Institute, Paris, France
| | - Alexandre Belot
- Department of Pediatric Nephrology, Rheumatology and Dermatology and Reference Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Hôpital Femme Mère Enfant, Bron, Lyon,France
| | - Laurence Cuisset
- Department of Molecular Genetics, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Albert Faye
- Université de Paris, Paris, France.,Department of General Paediatric, Infectious Diseases and Internal Medicine, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, Reference Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sophie Georgin-Lavialle
- Sorbonne University, Paris, France.,Department of Internal Medicine, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; National Reference Center of Autoinflammatory Disease and AA Amyloidosis.,Laboratoire Inserm, Paris, France
| | - Pierre Quartier
- Department of Paediatric Immunology, Hematology, and Rheumatology, Groupe Hospitalier Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Reference Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Assistance Publique-Hôpitaux de Paris, and Imagine Foundation, Paris, France.,Université de Paris, Paris, France
| | | | - Frank Ruemmele
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Groupe Hospitalier Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
| | - Florence Uettwiller
- Paediatric Rheumatology Unit, Centre Hospitalier Universitaire de Clocheville, Tours, France
| | - Jérôme Viala
- Université de Paris, Paris, France.,Department of Paediatric Gastro-enterology and Nutrition, Hôpital Universitaire Robert-Debré, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM UMR1149, Paris, France
| | - Nadine Cerf Bensussan
- Université de Paris, Paris, France.,Laboratory of Intestinal Immunity, Imagine Institute, Paris, France.,INSERM UMR1149, Paris, France
| | - Dominique Berrebi
- Université de Paris, Paris, France.,Department of Paediatric Pathology, Hôpital Robert-Debré, Hôpital Universitaire Robert-Debré, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris University, Paris, France
| | - Isabelle Melki
- Department of Paediatric Immunology, Hematology, and Rheumatology, Groupe Hospitalier Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Reference Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Assistance Publique-Hôpitaux de Paris, and Imagine Foundation, Paris, France.,Department of General Paediatric, Infectious Diseases and Internal Medicine, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, Reference Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Assistance Publique-Hôpitaux de Paris, Paris, France.,Laboratory of Neurogenetics and Neuroinflammation, Imagine Institute, Paris, France
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15
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Mercier JC, Maroni A, Levy M, Melki I, Meinzer U, Gaschignard J, Beyler C, Santos A. [COVID-19 in children: SARS-CoV-2-related inflammatory multisystem syndrome mimicking Kawasaki disease]. Bull Acad Natl Med 2021; 205:579-586. [PMID: 33753947 PMCID: PMC7969823 DOI: 10.1016/j.banm.2020.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/17/2020] [Indexed: 12/04/2022]
Abstract
SARS-CoV-2 pandemics is characterized by a high level of infectivity and a high mortality among adults at risk (older than 65 years, obesity, diabetes, systemic hypertension). Following a common viral pneumonia, a multisystem inflammatory syndrome sometimes occurs, including an Acute Respiratory Distress Syndrome (ARDS) carrying a high mortality. Unlike most common respiratory viruses, children seem less susceptible to SARS-CoV-2 infection and generally develop a mild disease with low mortality. However, clusters of severe shock associated with high levels of cardiac biomarkers and unusual vasoplegia requiring inotropes, vasopressors and volume loading have been recently described. Both clinical symptoms (i.e., high and persistent fever, gastrointestinal disorders, skin rash, conjunctivitis and dry cracked lips) and biological signs (e.g., elevated CRP/PCT, hyperferritinemia) resembled Kawasaki disease. In most instances, intravenous immunoglobin therapy improved the cardiac function and led to full recovery within a few days. However, adjunctive steroid therapy and sometimes biotherapy (e.g., anti-IL-1Ra, anti-IL-6 monoclonal antibodies) were often necessary. Although almost all children fully recovered within a week, some of them developed coronary artery dilation or aneurysm. Thus, a new 'Multisystem Inflammatory Syndrome associated with SARS-CoV-2' has been recently described in children and helps to better understand Kawasaki disease pathophysiology.
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Affiliation(s)
- J-C Mercier
- Professeur émérite, Université de Paris, Plateforme COVIDOM, AP-HP, ARS Île de France, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, 47, rue Copernic, 75116 Paris, France
| | - A Maroni
- CCA, PHC, Service de réanimation pédiatrique, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris
| | - M Levy
- CCA, PHC, Service de réanimation pédiatrique, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris
| | - I Melki
- PH, MCU-PH, PHU, Service de pédiatrie générale, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris
- Centre de référence pour les maladies rhumatologiques auto-immunes et systémiques (RAISE), Institut IMAGINE, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris
| | - U Meinzer
- PH, MCU-PH, PHU, Service de pédiatrie générale, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris
- Centre de recherche sur l'inflammation, Inserm UMR-1149, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris
| | - J Gaschignard
- PH, MCU-PH, PHU, Service de pédiatrie générale, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris
- Université de Paris, Faculté de médecine Paris Diderot, Site Bichat
| | - C Beyler
- PH, Service de cardiologie pédiatrique, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris
| | - A Santos
- PHC, Service des Urgences pédiatriques, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris
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16
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Mercier JC, Ouldali N, Melki I, Basmaci R, Levy M, Titomanlio L, Beyler C, Meinzer U. Severe acute respiratory syndrome coronavirus 2-related multisystem inflammatory syndrome in children mimicking Kawasaki disease. Arch Cardiovasc Dis 2021; 114:426-433. [PMID: 34052147 PMCID: PMC8141693 DOI: 10.1016/j.acvd.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 02/08/2023]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been characterized by high transmission rates and high mortality in adults with predisposing factors, including age > 70 years, obesity, diabetes, systemic hypertension and other underlying diseases. During the second week of viral pneumonia, acute respiratory distress syndrome can occur and carries high mortality. Unlike most common respiratory viruses, children seem to be less susceptible to SARS-CoV-2 infection, and generally develop mild disease with low mortality. However, clusters of severe shock associated with high levels of cardiac biomarkers and unusual vasoplegia requiring inotropes, vasopressors and volume loading have recently been described. Both the clinical symptoms (i.e. high and persistent fever, gastrointestinal disorders, skin rash, conjunctival injection and dry cracked lips) and the biological signs (e.g. elevated C-reactive protein/procalcitonin and high levels of ferritinaemia) mimicked Kawasaki disease. In most cases, intravenous immunoglobin therapy improved cardiac function and led to full recovery within a few days. Adjunctive steroid therapy and sometimes biotherapy (e.g. anti-interleukin 1Ra and anti-interleukin 6 monoclonal antibodies) were often necessary. Although almost all children fully recovered within a week, some of them later developed coronary artery dilation or aneurysm. Thus, a new “multisystem inflammatory syndrome in children” related to SARS-CoV-2 has recently been described. Similarities with Kawasaki disease and the physiopathology of this syndrome still need further exploration.
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Affiliation(s)
- Jean-Christophe Mercier
- Université de Paris, 75006 Paris, France; AP-HP et ARS Île de France, 93200 Saint-Denis, France.
| | - Naim Ouldali
- Service de Pédiatrie Générale, Hôpital Robert Debré, 75019 Paris, France
| | - Isabelle Melki
- Service de Pédiatrie Générale, Hôpital Robert Debré, 75019 Paris, France; Centre de Référence pour les Maladies Rhumatologiques Auto-Immunes et Systémiques (RAISE), Institut IMAGINE, 75015 Paris, France
| | - Romain Basmaci
- Service de Pédiatrie-Urgences, Hôpital Louis-Mourier, AP-HP, 92700 Colombes, France; Université de Paris, Inserm, Infection-Antimicrobials-Modelling-Evolution (IAME), UMR-1137, Université de Paris, Hôpital Bichat, 75018 Paris, France
| | - Michael Levy
- Service de Médecine Intensive-Réanimation Pédiatriques, Hôpital Robert-Debré, 75019 Paris, France
| | - Luigi Titomanlio
- Service des Urgences Pédiatriques, Hôpital Robert-Debré, 75019 Paris, France
| | - Constance Beyler
- Service de Cardiologie Pédiatrique, Hôpital Robert-Debré, 75019 Paris, France
| | - Ulrich Meinzer
- Service de Pédiatrie Générale, Hôpital Robert Debré, 75019 Paris, France; Centre de Recherche sur l'Inflammation, Inserm UMR-1149, 75018 Paris, France
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17
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Ouldali N, Toubiana J, Antona D, Javouhey E, Madhi F, Lorrot M, Léger PL, Galeotti C, Claude C, Wiedemann A, Lachaume N, Ovaert C, Dumortier M, Kahn JE, Mandelcwajg A, Percheron L, Biot B, Bordet J, Girardin ML, Yang DD, Grimaud M, Oualha M, Allali S, Bajolle F, Beyler C, Meinzer U, Levy M, Paulet AM, Levy C, Cohen R, Belot A, Angoulvant F. Association of Intravenous Immunoglobulins Plus Methylprednisolone vs Immunoglobulins Alone With Course of Fever in Multisystem Inflammatory Syndrome in Children. JAMA 2021; 325:855-864. [PMID: 33523115 PMCID: PMC7851757 DOI: 10.1001/jama.2021.0694] [Citation(s) in RCA: 208] [Impact Index Per Article: 69.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Multisystem inflammatory syndrome in children (MIS-C) is the most severe pediatric disease associated with severe acute respiratory syndrome coronavirus 2 infection, potentially life-threatening, but the optimal therapeutic strategy remains unknown. OBJECTIVE To compare intravenous immunoglobulins (IVIG) plus methylprednisolone vs IVIG alone as initial therapy in MIS-C. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study drawn from a national surveillance system with propensity score-matched analysis. All cases with suspected MIS-C were reported to the French National Public Health Agency. Confirmed MIS-C cases fulfilling the World Health Organization definition were included. The study started on April 1, 2020, and follow-up ended on January 6, 2021. EXPOSURES IVIG and methylprednisolone vs IVIG alone. MAIN OUTCOMES AND MEASURES The primary outcome was persistence of fever 2 days after the introduction of initial therapy or recrudescence of fever within 7 days, which defined treatment failure. Secondary outcomes included a second-line therapy, hemodynamic support, acute left ventricular dysfunction after first-line therapy, and length of stay in the pediatric intensive care unit. The primary analysis involved propensity score matching with a minimum caliper of 0.1. RESULTS Among 181 children with suspected MIS-C, 111 fulfilled the World Health Organization definition (58 females [52%]; median age, 8.6 years [interquartile range, 4.7 to 12.1]). Five children did not receive either treatment. Overall, 3 of 34 children (9%) in the IVIG and methylprednisolone group and 37 of 72 (51%) in the IVIG alone group did not respond to treatment. Treatment with IVIG and methylprednisolone vs IVIG alone was associated with lower risk of treatment failure (absolute risk difference, -0.28 [95% CI, -0.48 to -0.08]; odds ratio [OR], 0.25 [95% CI, 0.09 to 0.70]; P = .008). IVIG and methylprednisolone therapy vs IVIG alone was also significantly associated with lower risk of use of second-line therapy (absolute risk difference, -0.22 [95% CI, -0.40 to -0.04]; OR, 0.19 [95% CI, 0.06 to 0.61]; P = .004), hemodynamic support (absolute risk difference, -0.17 [95% CI, -0.34 to -0.004]; OR, 0.21 [95% CI, 0.06 to 0.76]), acute left ventricular dysfunction occurring after initial therapy (absolute risk difference, -0.18 [95% CI, -0.35 to -0.01]; OR, 0.20 [95% CI, 0.06 to 0.66]), and duration of stay in the pediatric intensive care unit (median, 4 vs 6 days; difference in days, -2.4 [95% CI, -4.0 to -0.7]). CONCLUSIONS AND RELEVANCE Among children with MIS-C, treatment with IVIG and methylprednisolone vs IVIG alone was associated with a more favorable fever course. Study interpretation is limited by the observational design.
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Affiliation(s)
- Naïm Ouldali
- Assistance Publique–Hôpitaux de Paris, Department of General Paediatrics, Paediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Université de Paris, Paris, France
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
- Université de Paris, INSERM UMR 1123, ECEVE, Paris, France
| | - Julie Toubiana
- Assistance Publique–Hôpitaux de Paris, Department of General Paediatrics and Paediatric Infectious Diseases, Necker-Enfants-Malades University Hospital, Université de Paris, Paris, France
- Institut Pasteur, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
| | - Denise Antona
- Santé Publique France, Agence Nationale de Santé Publique, Saint-Maurice, France
| | - Etienne Javouhey
- Hospices Civils de Lyon, Paediatric Intensive Care Unit, Hopital Femme, Mère Enfant, University of Lyon, Bron, France
- EA 7426 Pathophysiology of Injury-Induced Immunosuppression, University Claude Bernard Lyon 1, Hospices Civils of Lyon, Lyon, France
| | - Fouad Madhi
- Centre Hospitalier Intercommunal, Paediatric Department, Université Paris Est, IMRB-GRC GEMINI, Créteil, France
| | - Mathie Lorrot
- Assistance Publique–Hôpitaux de Paris, Department of General Paediatric, Armand Trousseau University Hospital, Sorbonne Université, Paris, France
| | - Pierre-Louis Léger
- Assistance Publique–Hôpitaux de Paris, Paediatric Intensive Care Unit, Armand Trousseau University Hospital, Sorbonne Université, Paris, France
| | - Caroline Galeotti
- Assistance Publique–Hôpitaux de Paris, Department of Paediatric Rheumatology, Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), Bicêtre University Hospital, Université de Paris Saclay, Le Kremlin-Bicêtre, France
| | - Caroline Claude
- Assistance Publique–Hôpitaux de Paris, Paediatric Intensive Care Unit, Bicêtre University Hospital, Université de Paris Saclay, Le Kremlin-Bicêtre, France
| | - Arnaud Wiedemann
- Children’s Hospital, University Hospital of Nancy, Paediatric Department, Université de Lorraine, Vandoeuvre les Nancy, France
- INSERM UMRS 1256 NGERE, Nutrition, Genetics, and Environmental Risk Exposure, National Center of Inborn Errors of Metabolism, Université de Lorraine, Vandoeuvre les Nancy, France
| | - Noémie Lachaume
- Assistance Publique–Hôpitaux de Paris, Paediatric Emergency Departement, Louis Mourier University Hospital, Colombes, France
| | - Caroline Ovaert
- Assistance Publique–Hôpitaux de Marseille, Paediatric and Congenital Cardiology, Timone Hospital Marseille, University Hospital, Marseille, France
- INSERM, Marseille Medical Genetics, UMR 1251, Aix Marseille Université, Marseille, France
| | - Morgane Dumortier
- Hôpital Femme Enfant Adolescent, Department of Paediatrics and Paediatric Emergency, University Hospital, Nantes, France
| | - Jean-Emmanuel Kahn
- Assistance Publique–Hôpitaux de Paris, Internal Medicine Department, Ambroise Paré University Hospital, Université Versailles-Saint Quentin-en-Yvelines, Boulogne-Billancourt, France
| | | | - Lucas Percheron
- Hôpital des Enfants, Paediatric Nephrology Department, Purpan University Hospital, Toulouse, France
| | - Blandine Biot
- Paediatric Department, Hôpital de Valence, Valence, France
| | - Jeanne Bordet
- Strasbourg University Hospital, Paediatric Cardiology Department, Hautepierre University Hospital, Strasbourg, France
| | - Marie-Laure Girardin
- Paediatric Intensive Care Unit, Strasbourg University Hospital, Hautepierre University Hospital, Strasbourg, France
| | - David Dawei Yang
- Assistance Publique–Hôpitaux de Paris, Paediatric Emergency Department, Necker-Enfants Malades University Hospital, Université de Paris, Paris, France
| | - Marion Grimaud
- Assistance Publique–Hôpitaux de Paris, Paediatric Intensive Care Unit, Necker-Enfants Malades University Hospital, EA7323, Université de Paris, Paris, France
| | - Mehdi Oualha
- Assistance Publique–Hôpitaux de Paris, Paediatric Intensive Care Unit, Necker-Enfants Malades University Hospital, EA7323, Université de Paris, Paris, France
| | - Slimane Allali
- Assistance Publique–Hôpitaux de Paris, Department of General Paediatrics and Paediatric Infectious Diseases, Necker-Enfants-Malades University Hospital, Université de Paris, Paris, France
| | - Fanny Bajolle
- Assistance Publique–Hôpitaux de Paris, M3C Department, Necker-Enfants Malades University Hospital, Université de Paris, Paris, France
| | - Constance Beyler
- Assistance Publique–Hôpitaux de Paris, Cardiopaediatric Unit, Robert Debré University Hospital, Université de Paris, Paris, France
| | - Ulrich Meinzer
- Assistance Publique–Hôpitaux de Paris, Department of General Paediatrics, Paediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Université de Paris, Paris, France
- Centre for Research on Inflammation, UMR1149, INSERM, Paris, France
| | - Michael Levy
- Assistance Publique–Hôpitaux de Paris, Paediatric Intensive Care Unit, Robert Debré University Hospital, Université de Paris, Paris, France
| | - Ana-Maria Paulet
- Hôpital Nord Franche-Comté, Paediatric Department, Trévenans, France
| | - Corinne Levy
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
- Centre Hospitalier Intercommunal, Research Centre, Université Paris Est, IMRB-GRC GEMINI, Créteil, France
| | - Robert Cohen
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
- Centre Hospitalier Intercommunal, Research Centre, Université Paris Est, IMRB-GRC GEMINI, Créteil, France
| | - Alexandre Belot
- Hospices Civils de Lyon, Paediatric Nephrology, Rheumatology, Dermatology, Hopital Femme, Mère Enfant, Centre International de Recherche en Infectiologie/INSERM U1111, Bron, France
| | - François Angoulvant
- Assistance Publique–Hôpitaux de Paris, Paediatric Emergency Department, Necker-Enfants Malades University Hospital, Université de Paris, Paris, France
- INSERM, Centre de Recherche des Cordeliers, UMRS 1138, Sorbonne Université, Université de Paris, Paris, France
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18
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Thomas M, Bonacorsi S, Simon AL, Mallet C, Lorrot M, Faye A, Dingulu G, Caseris M, Boneca IG, Aupiais C, Meinzer U. Acute monoarthritis in young children: comparing the characteristics of patients with juvenile idiopathic arthritis versus septic and undifferentiated arthritis. Sci Rep 2021; 11:3422. [PMID: 33564018 PMCID: PMC7873238 DOI: 10.1038/s41598-021-82553-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 01/12/2021] [Indexed: 11/17/2022] Open
Abstract
Acute arthritis is a common cause of consultation in pediatric emergency wards. Arthritis can be caused by juvenile idiopathic arthritis (JIA), septic (SA) or remain undetermined (UA). In young children, SA is mainly caused by Kingella kingae (KK), a hard to grow bacteria leading generally to a mild clinical and biological form of SA. An early accurate diagnosis between KK-SA and early-onset JIA is essential to provide appropriate treatment and follow-up. The aim of this work was to compare clinical and biological characteristics, length of hospital stays, duration of intravenous (IV) antibiotics exposure and use of invasive surgical management of patients under 6 years of age hospitalized for acute monoarthritis with a final diagnosis of JIA, SA or UA. We retrospectively analyzed data from < 6-year-old children, hospitalized at a French tertiary center for acute mono-arthritis, who underwent a joint aspiration. Non-parametric tests were performed to compare children with JIA, SA or UA. Bonferroni correction for multiple comparisons was applied with threshold for significance at 0.025. Among the 196 included patients, 110 (56.1%) had SA, 20 (10.2%) had JIA and 66 (33.7%) had UA. Patients with JIA were older when compared to SA (2.7 years [1.8–3.6] versus 1.4 [1.1–2.1], p < 0.001). Presence of fever was not different between JIA and SA or UA. White blood cells in serum were lower in JIA (11.2 × 109/L [10–13.6]) when compared to SA (13.2 × 109/L [11–16.6]), p = 0.01. In synovial fluid leucocytes were higher in SA 105.5 × 103 cells/mm3 [46–211] compared to JIA and UA (42 × 103 cells/mm3 [6.4–59.2] and 7.29 × 103 cells/mm3 [2.1–72] respectively), p < 0.001. Intravenous antibiotics were administered to 95% of children with JIA, 100% of patients with SA, and 95.4% of UA. Arthrotomy-lavage was performed in 66.7% of patients with JIA, 79.6% of patients with SA, and 71.1% of patients with UA. In children less than 6 years of age with acute mono-arthritis, the clinical and biological parameters currently used do not reliably differentiate between JIA, AS and UA. JIA subgroups that present a diagnostic problem at the onset of monoarthritis before the age of 6 years, are oligoarticular JIA and systemic JIA with hip arthritis. The development of new biomarkers will be required to distinguish JIA and AS caused by Kingellakingae in these patients.
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Affiliation(s)
- Marion Thomas
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases RAISE, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, 75019, Paris, France.,Institut Pasteur, Biology and Genetics of Bacterial Cell Wall Unit, Paris, France.,CNRS UMR2001, Paris, France.,INSERM, Equipe Avenir, Paris, France
| | - Stephane Bonacorsi
- Université de Paris, Paris, France.,Department of Microbiology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne-Laure Simon
- Université de Paris, Paris, France.,Pediatric Orthopedic Department, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cindy Mallet
- Université de Paris, Paris, France.,Pediatric Orthopedic Department, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mathie Lorrot
- Pediatric Department, Division of Infectious Diseases, Armand Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Albert Faye
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases RAISE, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, 75019, Paris, France.,Université de Paris, Paris, France
| | - Glory Dingulu
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases RAISE, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, 75019, Paris, France
| | - Marion Caseris
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases RAISE, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, 75019, Paris, France
| | - Ivo Gomperts Boneca
- Institut Pasteur, Biology and Genetics of Bacterial Cell Wall Unit, Paris, France.,CNRS UMR2001, Paris, France.,INSERM, Equipe Avenir, Paris, France
| | - Camille Aupiais
- Pediatric Emergency Department, Jean Verdier Hospital, Assistance Publique-Hôpitaux de Paris, Paris 13 University, Bondy, France.,INSERM, U1138, Equipe 22, Centre de Recherche des Cordeliers, Paris, France
| | - Ulrich Meinzer
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases RAISE, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, 75019, Paris, France. .,Institut Pasteur, Biology and Genetics of Bacterial Cell Wall Unit, Paris, France. .,CNRS UMR2001, Paris, France. .,INSERM, Equipe Avenir, Paris, France. .,Université de Paris, Paris, France. .,Centre de Recherche sur l'inflammation, UMR1149 INSERM et Université de Paris, Paris, France.
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19
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Koné-Paut I, Tellier S, Belot A, Brochard K, Guitton C, Marie I, Meinzer U, Cherqaoui B, Galeotti C, Boukhedouni N, Agostini H, Arditi M, Lambert V, Piedvache C. Phase II Open Label Study of Anakinra in Intravenous Immunoglobulin-Resistant Kawasaki Disease. Arthritis Rheumatol 2020; 73:151-161. [PMID: 32779863 DOI: 10.1002/art.41481] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/30/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Anakinra has been shown to be successful in preventing and treating cardiovascular lesions both in experimental murine models of Kawasaki disease (KD) and in several studies on intravenous immunoglobulin (IVIG)- and steroid-resistant patients with KD. This study was undertaken to determine the safety of blocking interleukin-1 in patients with IVIG-resistant KD. METHODS Sixteen patients were included in the present study. Patients with KD who were not responsive to 1 or more courses of 2 mg/kg of IVIG received anakinra by subcutaneous daily injections. Starting doses were 2 mg/kg of IVIG (4 mg/kg in patients who were age <8 months and who weighed ≥5 kilograms), and the dose was increased up to 6 mg/kg every 24 hours if the patient's body temperature remained >38°C, indicative of a fever. Treatment duration was 14 days. The last visit was on day 45. Primary outcome was abatement of fever. Secondary measures included disease activity, coronary artery Z score, and C-reactive protein (CRP) levels. RESULTS Seventy-five percent of patients in the intention-to-treat group and 87.5% in the per-protocol group became afebrile within 48 hours of the last escalation dose of anakinra. Reduction of disease activity by 50% was indicated on 93.3% (95% confidence interval [95% CI] 68.1-99.8%) of physician evaluations and on 100% (95% CI 73.5-100%) of parent evaluations. CRP values normalized by day 30. At the initial screening, 12 of 16 patients had a maximum coronary artery Z score of >2, and 10 of 16 patients had a maximum Z score of >2.5. At day 45, 5 of 10 patients (50% [95% CI 18.7-81.3%]) and 6 of 12 patients (50% [95% CI 21.1-78.9%]) had achieved coronary artery Z scores of <2.5 and <2, respectively. Five serious adverse events were observed in 3 patients, but no serious infections or deaths occurred. CONCLUSION Anakinra was well tolerated in the study patients and may have some efficacy in reducing fever, markers of systemic inflammation, and coronary artery dilatation in individuals with IVIG-refractory KD.
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Affiliation(s)
- Isabelle Koné-Paut
- CeRéMAIA, AP-HP, Bicêtre Hospital, University of Paris Sud Saclay, Paris, France
| | | | - Alexandre Belot
- University of Lyon, International Center for Research in Infectious Diseases, INSERM U1111, ENS, Lyon, France
| | | | - Corinne Guitton
- CeRéMAIA, AP-HP, Bicêtre Hospital, University of Paris Sud Saclay, Paris, France
| | - Isabelle Marie
- CeRéMAIA, AP-HP, Bicêtre Hospital, University of Paris Sud Saclay, Paris, France
| | | | - Bilade Cherqaoui
- CeRéMAIA, Bicêtre Hospital, AP-HP, University of Paris Sud Saclay, INSERM U1173, Paris, France
| | - Caroline Galeotti
- CeRéMAIA, AP-HP, Bicêtre Hospital, University of Paris Sud Saclay, Paris, France
| | | | - Helene Agostini
- AP-HP, University of Paris Saclay, Bicêtre Hospital, Paris, France
| | - Moshe Arditi
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Virginie Lambert
- Institut Mutualiste Montsouris and Bicêtre Hospital, AP-HP, University of Paris Sud Saclay, Paris, France
| | - Céline Piedvache
- AP-HP, University of Paris Saclay, Bicêtre Hospital, Paris, France
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20
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Borocco C, Pouletty M, Galeotti C, Meinzer U, Faye A, Koné-Paut I, Ouldali N, Melki I. Response to 'Correspondence on 'Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID19): a multicentre cohort'' by Mastrolia et al. Ann Rheum Dis 2020; 81:e219. [PMID: 33023959 DOI: 10.1136/annrheumdis-2020-218814] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 09/26/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Charlotte Borocco
- Department of Paediatric Rheumatology, Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), Bicêtre University Hospital, AP-HP, Le Kremlin-Bicetre, France.,University of Paris Sud Saclay, Paris, France
| | - Marie Pouletty
- General Pediatrics, Infectious Disease and Internal Medicine Department, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Hôpital Robert Debre, AP-HP, Paris, 75019, France
| | - Caroline Galeotti
- Department of Paediatric Rheumatology, Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), Bicêtre University Hospital, AP-HP, Le Kremlin-Bicetre, France
| | - Ulrich Meinzer
- General Pediatrics, Infectious Disease and Internal Medicine Department, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Hôpital Robert Debre, AP-HP, Paris, 75019, France.,Center for Research on Inflammation, UMR1149, INSERM, Paris, France
| | - Albert Faye
- General Pediatrics, Infectious Disease and Internal Medicine Department, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Hôpital Robert Debre, AP-HP, Paris, 75019, France.,UMR 1123, ECEVE, INSERM, Paris, France
| | - Isabelle Koné-Paut
- Department of Paediatric Rheumatology, Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), Bicêtre University Hospital, AP-HP, Le Kremlin-Bicetre, France.,University of Paris Sud Saclay, Paris, France
| | - Naim Ouldali
- General Pediatrics, Infectious Disease and Internal Medicine Department, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Hôpital Robert Debre, AP-HP, Paris, 75019, France.,UMR 1123, ECEVE, INSERM, Paris, France
| | - Isabelle Melki
- General Pediatrics, Infectious Disease and Internal Medicine Department, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Hôpital Robert Debre, AP-HP, Paris, 75019, France .,Laboratory of Neurogenetics and Neuroinflammation, Institute Imagine Institute of Genetic Diseases, Paris, France.,Pediatric Hematology-Immunology and Rheumatology Department, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Hôpital Necker-Enfants Malades, AP-HP, Paris, France
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21
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Mercier JC, Maroni A, Melki I, Meinzer U, Gaschignard J, Beyler C, Santos A. [Children and COVID-19]. Arch Mal Coeur Vaiss Pratique 2020; 2020:11-15. [PMID: 32837200 PMCID: PMC7366968 DOI: 10.1016/j.amcp.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- J-C Mercier
- Université de Paris, plateforme COVIDOM AP-HP, ARS Île-de-France, Millénaire 2, 35, rue de la Gare, 75019 Paris, France
| | - A Maroni
- Service de réanimation pédiatrique, groupe hospitalier universitaire, hôpital universitaire Robert-Debré, AP-HP Nord, boulevard Serrurier, 75019 Paris, France
| | - I Melki
- Service de pédiatrie générale, groupe hospitalier universitaire, hôpital universitaire Robert-Debré, AP-HP Nord, boulevard Serrurier, 75019 Paris, France
| | - U Meinzer
- Service de pédiatrie générale, groupe hospitalier universitaire, hôpital universitaire Robert-Debré, AP-HP Nord, boulevard Serrurier, 75019 Paris, France
| | - J Gaschignard
- Service de pédiatrie générale, groupe hospitalier universitaire, hôpital universitaire Robert-Debré, AP-HP Nord, boulevard Serrurier, 75019 Paris, France
| | - C Beyler
- Service de cardiologie pédiatrique, groupe hospitalier universitaire, hôpital universitaire Robert-Debré, AP-HP Nord, boulevard Serrurier, 75019 Paris, France
| | - A Santos
- Service des urgences pédiatriques, groupe hospitalier universitaire, hôpital universitaire Robert-Debré, AP-HP Nord, boulevard Serrurier, 75019 Paris, France
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22
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Abstract
Crohn's disease [CD] is an inflammatory bowel disease of unknown aetiology. During recent decades, significant technological advances led to development of -omic datasets allowing a detailed description of the disease. Unfortunately these have not, to date, resolved the question of the aetiology of CD. Thus, it may be necessary to [re]consider hypothesis-driven approaches to resolve the aetiology of CD. According to the cold chain hypothesis, the development of industrial and domestic refrigeration has led to frequent exposure of human populations to bacteria capable of growing in the cold. These bacteria, at low levels of exposure, particularly those of the genus Yersinia, are believed to be capable of inducing exacerbated inflammation of the intestine in genetically predisposed subjects. We discuss the consistency of this working hypothesis in light of recent data from epidemiological, clinical, pathological, microbiological, and molecular studies.
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Affiliation(s)
- Jean-Pierre Hugot
- Centre de recherche sur l’inflammation, UMR1149 INSERM and Université de Paris, Paris, France,Service des maladies digestives et respiratoires de l’enfant, Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris, Paris, France,Corresponding author: Jean-Pierre Hugot, MD, PhD, Service des maladies digestives et respiratoires de l’enfant, Hôpital Robert Debré, 48 Bd Sérurier, F75019 Paris, France. Tel.: [33] 1 40 03 57 12; fax: [33] 1 40 03 57 66;
| | - Anne Dumay
- Centre de recherche sur l’inflammation, UMR1149 INSERM and Université de Paris, Paris, France
| | - Frédérick Barreau
- IRSD, UMR1220, Université de Toulouse, INSERM, INRA, ENVT, UPS, Toulouse, France
| | - Ulrich Meinzer
- Centre de recherche sur l’inflammation, UMR1149 INSERM and Université de Paris, Paris, France,Service des maladies digestives et respiratoires de l’enfant, Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris, Paris, France
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23
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Pouletty M, Dingulu G, Ouldali N, Corseri O, Ducrocq C, Meinzer U, Faye A, Galeotti C, Melki I. Response to: 'Exaggerated neutrophil extracellular trap formation in Kawasaki disease: a key phenomenon behind the outbreak in western countries?' by Yamashita et al. Ann Rheum Dis 2020; 81:annrheumdis-2020-218644. [PMID: 32826274 DOI: 10.1136/annrheumdis-2020-218644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/08/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Marie Pouletty
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Robert Debré University Hospital, AP-HP, Paris, France
- Université de Paris, UFR de Médecine Paris Nord, 75010 Paris, France
| | - Glory Dingulu
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Robert Debré University Hospital, AP-HP, Paris, France
| | - Naim Ouldali
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Robert Debré University Hospital, AP-HP, Paris, France
- Université de Paris, UFR de Médecine Paris Nord, 75010 Paris, France
- INSERM UMR 1123, ECEVE, Paris, France
| | - Olivier Corseri
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Robert Debré University Hospital, AP-HP, Paris, France
| | - Camille Ducrocq
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Robert Debré University Hospital, AP-HP, Paris, France
- Université de Paris, UFR de Médecine Paris Nord, 75010 Paris, France
| | - Ulrich Meinzer
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Robert Debré University Hospital, AP-HP, Paris, France
- Université de Paris, UFR de Médecine Paris Nord, 75010 Paris, France
- Center for Research on Inflammation, UMR1149, INSERM, Paris, France
- Biology and Genetics of Bacterial Cell Wall Unit, Pasteur Institute, Paris, France
| | - Albert Faye
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Robert Debré University Hospital, AP-HP, Paris, France
- Université de Paris, UFR de Médecine Paris Nord, 75010 Paris, France
- INSERM UMR 1123, ECEVE, Paris, France
| | - Caroline Galeotti
- Department of Pediatric Rheumatology, Reference centre for Autoinflammatory diseases and amyloidosis (CEREMAIA), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - Isabelle Melki
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Robert Debré University Hospital, AP-HP, Paris, France
- Paediatric Hematology-Immunology and Rheumatology Department, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France, Necker-Enfants-Malades University Hospital, AP-HP, Paris, France
- Laboratory of Neurogenetics and Neuroinflammation, Imagine Institute, Paris, France
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Ouldali N, Pouletty M, Lokmer J, Benzouid C, Beyler C, Deho A, Meinzer U, Faye A, Melki I. Response to: 'Correspondence on 'Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort' by Pouletty et al' by Pino et al. Ann Rheum Dis 2020; 81:annrheumdis-2020-218614. [PMID: 32759261 DOI: 10.1136/annrheumdis-2020-218614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Naim Ouldali
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré University Hospital, AP-HP, Paris, France, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France
- Université de Paris, UFR de Médecine Paris Nord, Paris, France
- INSERM UMR 1123, ECEVE, Paris, France
| | - Marie Pouletty
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré University Hospital, AP-HP, Paris, France, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France
- Université de Paris, UFR de Médecine Paris Nord, Paris, France
| | - Johanna Lokmer
- Cardiopaediatric Unit, Robert Debré University Hospital, AP-HP, Paris, France
| | - Cherine Benzouid
- Cardiopaediatric Unit, Robert Debré University Hospital, AP-HP, Paris, France
| | - Constance Beyler
- Cardiopaediatric Unit, Robert Debré University Hospital, AP-HP, Paris, France
| | - Anna Deho
- Paediatric Intensive Care Unit, Robert Debré University Hospital, AP-HP, Paris, France
| | - Ulrich Meinzer
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré University Hospital, AP-HP, Paris, France, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France
- Université de Paris, UFR de Médecine Paris Nord, Paris, France
- Center for Research on Inflammation, INSERM, UMR1149, Paris, France
- Biology and Genetics of Bacterial Cell Wall Unit, Pasteur Institute, Paris, France
| | - Albert Faye
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré University Hospital, AP-HP, Paris, France, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France
- Université de Paris, UFR de Médecine Paris Nord, Paris, France
- INSERM UMR 1123, ECEVE, Paris, France
| | - Isabelle Melki
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré University Hospital, AP-HP, Paris, France, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France
- Université de Paris, UFR de Médecine Paris Nord, Paris, France
- Laboratory of Neurogenetics and Neuroinflammation, Imagine Institute, Paris, France
- Paediatric Hematology-Immunology and Rheumatology Department, Necker-Enfants-Malades University Hospital, AP-HP, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France
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Pouletty M, Borocco C, Ouldali N, Caseris M, Basmaci R, Lachaume N, Bensaid P, Pichard S, Kouider H, Morelle G, Craiu I, Pondarre C, Deho A, Maroni A, Oualha M, Amoura Z, Haroche J, Chommeloux J, Bajolle F, Beyler C, Bonacorsi S, Carcelain G, Koné-Paut I, Bader-Meunier B, Faye A, Meinzer U, Galeotti C, Melki I. Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort. Ann Rheum Dis 2020; 79:999-1006. [PMID: 32527868 PMCID: PMC7299653 DOI: 10.1136/annrheumdis-2020-217960] [Citation(s) in RCA: 341] [Impact Index Per Article: 85.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/27/2020] [Accepted: 06/02/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Current data suggest that COVID-19 is less frequent in children, with a milder course. However, over the past weeks, an increase in the number of children presenting to hospitals in the greater Paris region with a phenotype resembling Kawasaki disease (KD) has led to an alert by the French national health authorities. METHODS Multicentre compilation of patients with KD in Paris region since April 2020, associated with the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ('Kawa-COVID-19'). A historical cohort of 'classical' KD served as a comparator. RESULTS Sixteen patients were included (sex ratio=1, median age 10 years IQR (4·7 to 12.5)). SARS-CoV-2 was detected in 12 cases (69%), while a further three cases had documented recent contact with a quantitative PCR-positive individual (19%). Cardiac involvement included myocarditis in 44% (n=7). Factors prognostic for the development of severe disease (ie, requiring intensive care, n=7) were age over 5 years and ferritinaemia >1400 µg/L. Only five patients (31%) were successfully treated with a single intravenous immunoglobulin (IVIg) infusion, while 10 patients (62%) required a second line of treatment. The Kawa-COVID-19 cohort differed from a comparator group of 'classical' KD by older age at onset 10 vs 2 years (p<0.0001), lower platelet count (188 vs 383 G/L (p<0.0001)), a higher rate of myocarditis 7/16 vs 3/220 (p=0.0001) and resistance to first IVIg treatment 10/16 vs 45/220 (p=0.004). CONCLUSION Kawa-COVID-19 likely represents a new systemic inflammatory syndrome temporally associated with SARS-CoV-2 infection in children. Further prospective international studies are necessary to confirm these findings and better understand the pathophysiology of Kawa-COVID-19. Trial registration number NCT02377245.
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Affiliation(s)
- Marie Pouletty
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France, Robert Debré University Hospital, AP-HP, Paris, France
- Université de Paris, UFR de Médecine Paris Nord, 75010 Paris, France
| | - Charlotte Borocco
- Department of Pediatric Rheumatology Reference centre for Autoinflammatory diseases and amyloidosis (CEREMAIA), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
- Université Paris Sud-Saclay, UVSQ, 94276 Le Kremlin-Bicêtre, France
| | - Naim Ouldali
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France, Robert Debré University Hospital, AP-HP, Paris, France
- INSERM UMR 1123, ECEVE, Paris, France
| | - Marion Caseris
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France, Robert Debré University Hospital, AP-HP, Paris, France
- Department of Microbiology, Robert Debré University Hospital,AP-HP, Paris, France
| | - Romain Basmaci
- Departments of General Paediatrics and Paediatric Emergency, Louis-Mourier Hospital, AP-HP, Colombes, France
- Infection-Antimicrobials-Modelling-Evolution IAME, INSERM, UMR-1137, Université de Paris, 75018, Paris, France
| | - Noémie Lachaume
- Departments of General Paediatrics and Paediatric Emergency, Louis-Mourier Hospital, AP-HP, Colombes, France
- Infection-Antimicrobials-Modelling-Evolution IAME, INSERM, UMR-1137, Université de Paris, 75018, Paris, France
| | - Philippe Bensaid
- Department of General Paediatrics, Victor Dupouy Hospital, Argenteuil, France
| | - Samia Pichard
- Department of General Paediatrics, Victor Dupouy Hospital, Argenteuil, France
| | - Hanane Kouider
- Department of General Paediatrics, René Dubos, Pontoise Hospital, Pontoise, France
| | - Guillaume Morelle
- Department of General Paediatrics, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - Irina Craiu
- Paediatric emergency Department, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - Corinne Pondarre
- Sickle cell disease referal center, INSERM U955, Centre hospitalier Intercommunal de Créteil, Paris XII University, Créteil, France
| | - Anna Deho
- Paediatric Intensive Care Unit, Robert Debré University Hospital, AP-HP, Paris, France
| | - Arielle Maroni
- Paediatric Intensive Care Unit, Robert Debré University Hospital, AP-HP, Paris, France
| | - Mehdi Oualha
- Paediatric Intensive Care Unit, Necker-Enfants-Malades University Hospital, AP-HP, Paris, France
| | - Zahir Amoura
- Inserm UMR-S 1135, Sorbonne Université, Paris, France
- Department of Immunology and Infectious disease (CIMI-Paris), Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Julien Haroche
- Inserm UMR-S 1135, Sorbonne Université, Paris, France
- Department of Immunology and Infectious disease (CIMI-Paris), Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Juliette Chommeloux
- Medical Intensive Care Unit, Institut de Cardiologie, AP-HP, Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
| | - Fanny Bajolle
- Cardiopaediatric Unit, M3-C, Necker-Enfants-Malades University Hospital, AP-HP, Paris, France
| | - Constance Beyler
- Cardiopaediatric Unit, Robert Debré University Hospital, AP-HP, Paris, France
| | - Stéphane Bonacorsi
- Department of Microbiology, Robert Debré University Hospital,AP-HP, Paris, France
- Infection-Antimicrobials-Modelling-Evolution IAME, INSERM, UMR-1137, Université de Paris, 75018, Paris, France
| | - Guislaine Carcelain
- Department of Immunology, Robert Debré University Hospital, AP-HP, Paris, France
| | - Isabelle Koné-Paut
- Department of Pediatric Rheumatology Reference centre for Autoinflammatory diseases and amyloidosis (CEREMAIA), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
- Université Paris Sud-Saclay, UVSQ, 94276 Le Kremlin-Bicêtre, France
| | - Brigitte Bader-Meunier
- Paediatric Hematology-Immunology and Rheumatology Department, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France, Necker-Enfants-Malades University Hospital, AP-HP, Paris, France
- Laboratory of Immunogenetics of paediatric autoimmune diseases, INSERM UMR 1163, Paris, France
| | - Albert Faye
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France, Robert Debré University Hospital, AP-HP, Paris, France
- Université de Paris, UFR de Médecine Paris Nord, 75010 Paris, France
- INSERM UMR 1123, ECEVE, Paris, France
| | - Ulrich Meinzer
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France, Robert Debré University Hospital, AP-HP, Paris, France
- Université de Paris, UFR de Médecine Paris Nord, 75010 Paris, France
- Center for Research on Inflammation, INSERM, UMR1149, Paris, France
- Biology and Genetics of Bacterial Cell Wall Unit, Pasteur Institute, Paris, France
| | - Caroline Galeotti
- Department of Pediatric Rheumatology Reference centre for Autoinflammatory diseases and amyloidosis (CEREMAIA), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - Isabelle Melki
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France, Robert Debré University Hospital, AP-HP, Paris, France
- Paediatric Hematology-Immunology and Rheumatology Department, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Paris, France, Necker-Enfants-Malades University Hospital, AP-HP, Paris, France
- Laboratory of Neurogenetics and Neuroinflammation, Imagine Institute, Paris, France
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Ouldali N, Pouletty M, Mariani P, Beyler C, Blachier A, Bonacorsi S, Danis K, Chomton M, Maurice L, Le Bourgeois F, Caseris M, Gaschignard J, Poline J, Cohen R, Titomanlio L, Faye A, Melki I, Meinzer U. Emergence of Kawasaki disease related to SARS-CoV-2 infection in an epicentre of the French COVID-19 epidemic: a time-series analysis. Lancet Child Adolesc Health 2020; 4:662-668. [PMID: 32622376 PMCID: PMC7332278 DOI: 10.1016/s2352-4642(20)30175-9] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 12/13/2022]
Abstract
Background Kawasaki disease is an acute febrile systemic childhood vasculitis, which is suspected to be triggered by respiratory viral infections. We aimed to examine whether the ongoing COVID-19 epidemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with an increase in the incidence of Kawasaki disease. Methods We did a quasi-experimental interrupted time series analysis over the past 15 years in a tertiary paediatric centre in the Paris region, a French epicentre of the COVID-19 outbreak. The main outcome was the number of Kawasaki disease cases over time, estimated by quasi-Poisson regression. In the same centre, we recorded the number of hospital admissions from the emergency department (2005–2020) and the results of nasopharyngeal multiplex PCR to identify respiratory pathogens (2017–2020). These data were compared with daily hospital admissions due to confirmed COVID-19 in the same region, recorded by Public Health France. Findings Between Dec 1, 2005, and May 20, 2020, we included 230 patients with Kawasaki disease. The median number of Kawasaki disease hospitalisations estimated by the quasi-Poisson model was 1·2 per month (IQR 1·1–1·3). In April, 2020, we identified a rapid increase of Kawasaki disease that was related to SARS-CoV-2 (six cases per month; 497% increase [95% CI 72–1082]; p=0·0011), starting 2 weeks after the peak of the COVID-19 epidemic. SARS-CoV-2 was the only virus circulating intensely during this period, and was found in eight (80%) of ten patients with Kawasaki disease since April 15 (SARS-CoV-2-positive PCR or serology). A second peak of hospital admissions due to Kawasaki disease was observed in December, 2009 (six cases per month; 365% increase ([31–719]; p=0.0053), concomitant with the influenza A H1N1 pandemic. Interpretation Our study further suggests that viral respiratory infections, including SAR-CoV-2, could be triggers for Kawasaki disease and indicates the potential timing of an increase in incidence of the disease in COVID-19 epidemics. Health-care providers should be prepared to manage an influx of patients with severe Kawasaki disease, particularly in countries where the peak of COVID-19 has recently been reached. Funding French National Research Agency.
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Affiliation(s)
- Naim Ouldali
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Referee Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, INSERM UMR 1123, ECEVE, Paris, France; Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; Université de Paris, UFR de Médecine Paris Nord, Paris, France
| | - Marie Pouletty
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Referee Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, UFR de Médecine Paris Nord, Paris, France
| | - Patricia Mariani
- Université de Paris, UFR de Médecine Paris Nord, Paris, France; Department of Microbiology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Constance Beyler
- Department of Pediatric Cardiology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Audrey Blachier
- Department of Medical Information, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stephane Bonacorsi
- Université de Paris, UFR de Médecine Paris Nord, Paris, France; Department of Microbiology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, IAME, INSERM UMR1137, Paris, France
| | | | - Maryline Chomton
- Paediatric Intensive Care Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laure Maurice
- Paediatric Intensive Care Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fleur Le Bourgeois
- Paediatric Intensive Care Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marion Caseris
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Referee Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Department of Microbiology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean Gaschignard
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Referee Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, UFR de Médecine Paris Nord, Paris, France; Université de Paris, IAME, INSERM UMR1137, Paris, France
| | - Julie Poline
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Referee Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Center for Research on Inflammation, INSERM, UMR1149, Paris, France
| | - Robert Cohen
- Université de Paris, UFR de Médecine Paris Nord, Paris, France
| | - Luigi Titomanlio
- Université de Paris, UFR de Médecine Paris Nord, Paris, France; Department of Paediatric Emergency Care, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Albert Faye
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Referee Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, INSERM UMR 1123, ECEVE, Paris, France; Université de Paris, UFR de Médecine Paris Nord, Paris, France
| | - Isabelle Melki
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Referee Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Laboratory of Neurogenetics and Neuroinflammation, Imagine Institute, Paris, France; Paediatric Haematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, National Referee Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Paris, France
| | - Ulrich Meinzer
- Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Referee Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, UFR de Médecine Paris Nord, Paris, France; Center for Research on Inflammation, INSERM, UMR1149, Paris, France; Biology and Genetics of Bacterial Cell Wall Unit, Pasteur Institute, Paris, France.
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Affiliation(s)
- Julie Poline
- Department of General Pediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Paediatric Inflammatory Rheumatisms and Systemic Auto-immune diseases RAISE, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris; Université Paris Diderot-Sorbonne Paris-Cité, INSERM, UMR1149; Biology and Genetics of Bacterial Cell Wall Unit, Pasteur Institute, Paris, France
| | - Emmanuelle Bourrat
- Department of General Pediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Paediatric Inflammatory Rheumatisms and Systemic Auto-immune diseases RAISE, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris; Department of Dermatology, Saint Louis University Hospital, Assistance Publique-Hôpitaux de Paris
| | - Ulrich Meinzer
- Department of General Pediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Paediatric Inflammatory Rheumatisms and Systemic Auto-immune diseases RAISE, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris; Université Paris Diderot-Sorbonne Paris-Cité, INSERM, UMR1149; Biology and Genetics of Bacterial Cell Wall Unit, Pasteur Institute, Paris, France
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Meinzer U, See H, Bader-Meunier B, Juillard C, Duquesne A, Melki I, Faye A, Bourrat E. Clinical Characteristics of Acne Fulminans Associated With Chronic Nonbacterial Osteomyelitis in Pediatric Patients. J Rheumatol 2020; 47:1793-1799. [PMID: 32238518 DOI: 10.3899/jrheum.191232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Acne fulminans (AF) is a rare, explosive systemic form of acne. Chronic nonbacterial osteomyelitis (CNO) or chronic recurrent multifocal osteomyelitis (CRMO) is a primarily pediatric autoinflammatory disorder characterized by sterile osteolytic bone lesions. Concomitant occurrence of CNO/CRMO and AF is very rare, and little is known about the epidemiological and clinical particularities of this association. The aim of this retrospective observational study was to describe the characteristics of pediatric patients with CNO/CRMO associated to AF. METHODS Electronic mailing lists of French medical societies were used to call for patients with CNO/CRMO and AF. A search for published patients with CNO/CRMO and AF was performed by screening PubMed. RESULTS We identified 5 original patients and 10 patients from the literature. All patients were adolescent boys. Mean age at disease onset was 14.8 years. Nine of 15 patients had received isotretinoin before the sudden onset of AF. Osteoarticular symptoms appeared within < 1-3 months after the onset of AF. The mean numbers of clinical and radiological bone lesions were 3.6 and 5.6, respectively. The percentages of patients with involvement of vertebrae, pelvis, chest, and cranial were 40%, 40%, 33.3%, and 6.6%, respectively. Arthritis was observed in 69.2% of patients and sacroiliac arthritis in 46.2%. CONCLUSION CNO/CRMO associated to AF occurs predominantly in male adolescents and is characterized by frequent involvement of the axial skeleton and arthritis. Epidemiological and clinical features of these patients differ from general CNO/CRMO cohorts. Clinical management requires careful handling of isotretinoin doses.
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Affiliation(s)
- Ulrich Meinzer
- U. Meinzer, MD, PhD, Department of General Pediatrics, Pediatric Infectious Diseases and Pediatric Rheumatology, Hôpital Robert Debré, AP-HP, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Auto-immune diseases (RAISE), and Université Paris Diderot-Sorbonne Paris-Cité, INSERM, UMR1149, and Biology and Genetics of Bacterial Cell Wall Unit, Institut Pasteur, Paris;
| | - Helene See
- H. See, MD, I. Melki, MD, PhD, Department of General Pediatrics, Pediatric Infectious Diseases and Pediatric Rheumatology, Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris AP-HP, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Auto-immune diseases (RAISE), Paris
| | - Brigitte Bader-Meunier
- B. Bader-Meunier, MD, Pediatric Hematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, AP-HP, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Auto-immune diseases (RAISE), Paris
| | - Caroline Juillard
- C. Juillard, MD, Department of Dermatology, Hôpital Saint-Louis, Paris
| | - Agnes Duquesne
- A. Duquesne, MD, Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Auto-immune diseases (RAISE), Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon
| | - Isabelle Melki
- H. See, MD, I. Melki, MD, PhD, Department of General Pediatrics, Pediatric Infectious Diseases and Pediatric Rheumatology, Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris AP-HP, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Auto-immune diseases (RAISE), Paris
| | - Albert Faye
- A. Faye, MD, PhD, Department of General Pediatrics, Pediatric Infectious Diseases and Pediatric Rheumatology, Hôpital Robert Debré, AP-HP, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Auto-immune diseases (RAISE), and Biology and Genetics of Bacterial Cell Wall Unit, Institut Pasteur, Paris
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Piram M, Darce Bello M, Tellier S, Di Filippo S, Boralevi F, Madhi F, Meinzer U, Cimaz R, Piedvache C, Koné-Paut I. Defining the risk of first intravenous immunoglobulin unresponsiveness in non-Asian patients with Kawasaki disease. Sci Rep 2020; 10:3125. [PMID: 32080307 PMCID: PMC7033244 DOI: 10.1038/s41598-020-59972-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 01/27/2020] [Indexed: 11/22/2022] Open
Abstract
About 10–20% of patients with Kawasaki disease (KD) are unresponsive to intravenous immunoglobulin (IVIg) and are at increased risk of coronary artery abnormalities (CAAs). Early identification is critical to initiate aggressive therapies, but available scoring systems lack sensitivity in non-Japanese populations. We investigated the accuracy of 3 Japanese scoring systems and studied factors associated with IVIg unresponsiveness in a large multiethnic French population of children with KD to build a new scoring system. Children admitted for KD between 2011–2014 in 65 centers were enrolled. Factors associated with second line-treatment; i.e. unresponsiveness to initial IVIg treatment, were analyzed by multivariate regression analysis. The performance of our score and the Kobayashi, Egami and Sano scores were compared in our population and in ethnic subgroups. Overall, 465 children were reported by 84 physicians; 425 were classified with KD (55% European Caucasian, 12% North African/Middle Eastern, 10% African/Afro-Caribbean, 3% Asian and 11% mixed). Eighty patients (23%) needed second-line treatment. Japanese scores had poor performance in our whole population (sensitivity 14–61%). On multivariate regression analysis, predictors of secondary treatment after initial IVIG were hepatomegaly, ALT level ≥30 IU/L, lymphocyte count <2400/mm3 and time to treatment <5 days. The best sensitivity (77%) and specificity (60%) of this model was with 1 point per variable and cut-off ≥2 points. The sensitivity remained good in our 3 main ethnic subgroups (74–88%). We identified predictors of IVIg resistance and built a new score with good sensitivity and acceptable specificity in a non-Asian population.
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Affiliation(s)
- Maryam Piram
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Inserm, 1018, Le Kremlin Bicêtre, France. .,AP-HP, CHU de Bicêtre, Pediatric Rheumatology, CEREMAIA, Le Kremlin Bicêtre, France.
| | - Martha Darce Bello
- AP-HP, CHU de Bicêtre, Pediatric Rheumatology, CEREMAIA, Le Kremlin Bicêtre, France
| | - Stéphanie Tellier
- CHU de de Toulouse, Paediatric Rheumatology, Nephrology and Internal medicine, Toulouse, France
| | | | | | | | - Ulrich Meinzer
- APHP, CHU Robert Debré, Paediatrics,Paediatric Internal Medicine,Rheumatology and Infectious Diseases, RAISE, Paris, France
| | - Rolando Cimaz
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Celine Piedvache
- APHP, CHU de Bicêtre, Clinical Research Unit, Le Kremlin Bicêtre, France
| | - Isabelle Koné-Paut
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Inserm, 1018, Le Kremlin Bicêtre, France.,AP-HP, CHU de Bicêtre, Pediatric Rheumatology, CEREMAIA, Le Kremlin Bicêtre, France
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Louvigné M, Rakotonjanahary J, Goumy L, Tavenard A, Brasme JF, Rialland F, Baruchel A, Auclerc MF, Despert V, Desgranges M, Jean S, Faye A, Meinzer U, Lorrot M, Job-Deslandre C, Bader-Meunier B, Gandemer V, Pellier I. Persistent osteoarticular pain in children: early clinical and laboratory findings suggestive of acute lymphoblastic leukemia (a multicenter case-control study of 147 patients). Pediatr Rheumatol Online J 2020; 18:1. [PMID: 31898528 PMCID: PMC6941319 DOI: 10.1186/s12969-019-0376-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/29/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The aim of this study was to identify early clinical and laboratory features that distinguish acute lymphoblastic leukemia (ALL) from juvenile idiopathic arthritis (JIA) in children presenting with persistent bone or joint pain for at least 1 month. METHODS We performed a multicenter case-control study and reviewed medical records of children who initially presented with bone or joint pain lasting for at least 1 month, all of whom were given a secondary diagnosis of JIA or ALL, in four French University Hospitals. Each patient with ALL was paired by age with two children with JIA. Logistic regression was used to compare clinical and laboratory data from the two groups. RESULTS Forty-nine children with ALL and 98 with JIA were included. The single most important feature distinguishing ALL from JIA was the presence of hepatomegaly, splenomegaly or lymphadenopathy; at least one of these manifestations was present in 37 cases with ALL, but only in 2 controls with JIA, for an odds ratio (OR) of 154 [95%CI: 30-793] (regression coefficient: 5.0). If the presence of these findings is missed or disregarded, multivariate analyses showed that non-articular bone pain and/or general symptoms (asthenia, anorexia or weight loss) (regression coefficient: 4.8, OR 124 [95%CI: 11.4-236]), neutrophils < 2 × 109/L (regression coefficient: 3.9, OR 50 [95%CI: 4.3-58]), and platelets < 300 × 109/L (regression coefficient: 2.6, OR 14 [95%CI: 2.3-83.9]) were associated with the presence of ALL (area under the ROC curve: 0.96 [95%CI: 0.93-0.99]). CONCLUSIONS Based on our findings we propose the following preliminary decision tree to be tested in prospective studies: in children presenting with at least 1 month of osteoarticular pain and no obvious ALL in peripheral smear, perform a bone marrow examination if hepatomegaly, splenomegaly or lymphadenopathy is present. If these manifestations are absent, perform a bone marrow examination if there is fever or elevated inflammatory markers associated with non-articular bone pain, general symptoms (asthenia, anorexia or weight loss), neutrophils < 2 × 109/L or platelets < 300 × 109/L.
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Affiliation(s)
- Mathilde Louvigné
- Unité d'Onco-Hémato-Immunologie pédiatrique, CHU Angers, 4 rue Larrey, 49933, Angers, France.
| | - Josué Rakotonjanahary
- 0000 0004 0472 0283grid.411147.6Unité d’Onco-Hémato-Immunologie pédiatrique, CHU Angers, 4 rue Larrey, 49933 Angers, France
| | - Laurence Goumy
- 0000 0004 0472 0283grid.411147.6Service de Pédiatrie générale, CHU Angers, Angers, France
| | - Aude Tavenard
- 0000 0001 2175 0984grid.411154.4Unité d’Onco-Hémato-Immunologie pédiatrique, CHU Rennes, Rennes, France
| | - Jean-François Brasme
- 0000 0004 0472 0283grid.411147.6Unité d’Onco-Hémato-Immunologie pédiatrique, CHU Angers, 4 rue Larrey, 49933 Angers, France
| | - Fanny Rialland
- 0000 0004 0472 0371grid.277151.7Unité d’Onco-Hémato-Immunologie pédiatrique, CHU Nantes, Nantes, France
| | - André Baruchel
- 0000 0001 2175 4109grid.50550.35Unité d’Hémato-Immunologie pédiatrique, CHU Robert Debré, Hôpitaux de Paris, Paris, France
| | - Marie-Françoise Auclerc
- 0000 0001 2175 4109grid.50550.35Unité d’Hémato-Immunologie pédiatrique, CHU Robert Debré, Hôpitaux de Paris, Paris, France ,Université de Paris, UFR Paris Diderot, Paris, France
| | - Véronique Despert
- 0000 0001 2175 0984grid.411154.4Service de Pédiatrie générale, CHU Rennes, Rennes, France
| | - Marie Desgranges
- 0000 0001 2175 0984grid.411154.4Service de Pédiatrie générale, CHU Rennes, Rennes, France
| | - Sylvie Jean
- 0000 0001 2175 0984grid.411154.4Service de Pédiatrie générale, CHU Rennes, Rennes, France
| | - Albert Faye
- Université de Paris, UFR Paris Diderot, Paris, France ,0000 0001 2175 4109grid.50550.35Service de Pédiatrie générale Maladies Infectieuses et Médecine Interne, Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l’enfant RAISE, CHU Robert Debré, Hôpitaux de Paris, Paris, France
| | - Ulrich Meinzer
- 0000 0001 2175 4109grid.50550.35Service de Pédiatrie générale Maladies Infectieuses et Médecine Interne, Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l’enfant RAISE, CHU Robert Debré, Hôpitaux de Paris, Paris, France
| | - Mathie Lorrot
- 0000 0001 2175 4109grid.50550.35Service de Pédiatrie générale Maladies Infectieuses et Médecine Interne, Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l’enfant RAISE, CHU Robert Debré, Hôpitaux de Paris, Paris, France
| | - Chantal Job-Deslandre
- 0000 0001 2175 4109grid.50550.35Service de Pédiatrie générale Maladies Infectieuses et Médecine Interne, Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l’enfant RAISE, CHU Robert Debré, Hôpitaux de Paris, Paris, France
| | - Brigitte Bader-Meunier
- 0000 0004 0593 9113grid.412134.1Unité d’Immuno-Hématologie et Rhumatologie Pédiatriques, Hôpital Necker-Enfants Malades, Hôpitaux de Paris, Paris, France
| | - Virginie Gandemer
- 0000 0001 2175 0984grid.411154.4Unité d’Onco-Hémato-Immunologie pédiatrique, CHU Rennes, Rennes, France
| | - Isabelle Pellier
- 0000 0004 0472 0283grid.411147.6Unité d’Onco-Hémato-Immunologie pédiatrique, CHU Angers, 4 rue Larrey, 49933 Angers, France
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Poline J, Fogel O, Pajot C, Miceli‐Richard C, Rybojad M, Galeotti C, Grouteau E, Hachulla E, Brissaud P, Cantagrel A, Mazereeuw Hautier J, Melki I, Petit A, Piram M, Sarrabay G, Wouters C, Vignon‐Pennamen M, Bourrat E, Meinzer U. Early‐onset granulomatous arthritis, uveitis and skin rash: characterization of skin involvement in Blau syndrome. J Eur Acad Dermatol Venereol 2019; 34:340-348. [DOI: 10.1111/jdv.15963] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/26/2019] [Indexed: 01/21/2023]
Affiliation(s)
- J. Poline
- Department of General Pediatrics Paediatric Internal Medicine, Rheumatology and Infectious Diseases National Reference Centre for Rare Paediatric Inflammatory Rheumatisms and Systemic Auto‐immune diseases RAISE Robert Debré University Hospital Assistance Publique‐Hôpitaux de Paris Paris France
- INSERM UMR1149 Université Paris Diderot‐Sorbonne Paris‐Cité Paris France
| | - O. Fogel
- Department of Rheumatology Cochin University Hospital Assistance Publique‐Hôpitaux de Paris ParisFrance
| | - C. Pajot
- Department of Paediatric Nephrology and Internal Medicine Purpan University Hospital Toulouse France
| | - C. Miceli‐Richard
- Department of Rheumatology Cochin University Hospital Assistance Publique‐Hôpitaux de Paris ParisFrance
| | - M. Rybojad
- Department of Dermatology Saint Louis University Hospital Assistance Publique‐Hôpitaux de Paris Paris France
| | - C. Galeotti
- Department of Paediatric Rheumatology National Reference Centre for Auto‐inflammatory Diseases CEREMAIA Kremlin Bicêtre University Hospital Assistance Publique‐Hôpitaux de Paris Kremlin Bicêtre France
| | - E. Grouteau
- Department of Paediatric Emergencies Purpan University Hospital Toulouse France
| | - E. Hachulla
- Department of Internal Medicine and Clinical Immunology Referral Centre for Rare Systemic and Auto‐immunes Diseases C. Huriez University Hospital Lille France
| | - P. Brissaud
- Department of Rheumatology Bichat‐Claude Bernard University Hospital Assistance Publique‐Hôpitaux de Paris Paris France
| | - A. Cantagrel
- Department of Rheumatology Purpan University Hospital Toulouse France
| | - J. Mazereeuw Hautier
- Department of Dermatology Larrey Hospital Paul Sabatier University Toulouse France
| | - I. Melki
- Department of General Pediatrics Paediatric Internal Medicine, Rheumatology and Infectious Diseases National Reference Centre for Rare Paediatric Inflammatory Rheumatisms and Systemic Auto‐immune diseases RAISE Robert Debré University Hospital Assistance Publique‐Hôpitaux de Paris Paris France
| | - A. Petit
- Department of Pediatric Hematology and Oncology Assistance Publique‐Hôpitaux de Paris GH HUEP Armand Trousseau Hospital Paris France
- UMRS_938 CDR Saint‐Antoine Sorbonne Université Paris France
| | - M. Piram
- Department of Paediatric Rheumatology National Reference Centre for Auto‐inflammatory Diseases CEREMAIA Kremlin Bicêtre University Hospital Assistance Publique‐Hôpitaux de Paris Kremlin Bicêtre France
| | - G. Sarrabay
- Department of Medical Genetics Rare diseases and Personalized medicine Rare and Autoinflammatory diseases unit Montpellier University Hospital University of Montpellier Montpellier France
| | - C. Wouters
- Department of Paediatric Rheumatology Leuven University Hospital Leuven Belgium
| | - M.D. Vignon‐Pennamen
- Department of Anatomopathology Saint Louis University Hospital Assistance Publique‐Hôpitaux de Paris Paris France
| | - E. Bourrat
- Department of General Pediatrics Paediatric Internal Medicine, Rheumatology and Infectious Diseases National Reference Centre for Rare Paediatric Inflammatory Rheumatisms and Systemic Auto‐immune diseases RAISE Robert Debré University Hospital Assistance Publique‐Hôpitaux de Paris Paris France
- Department of Dermatology Saint Louis University Hospital Assistance Publique‐Hôpitaux de Paris Paris France
| | - U. Meinzer
- Department of General Pediatrics Paediatric Internal Medicine, Rheumatology and Infectious Diseases National Reference Centre for Rare Paediatric Inflammatory Rheumatisms and Systemic Auto‐immune diseases RAISE Robert Debré University Hospital Assistance Publique‐Hôpitaux de Paris Paris France
- INSERM UMR1149 Université Paris Diderot‐Sorbonne Paris‐Cité Paris France
- Biology and Genetics of Bacterial Cell Wall Unit Pasteur Institute Paris France
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32
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Bucchia M, Barbarot S, Reumaux H, Piram M, Mahe E, Mallet S, Balguerie X, Phan A, Lacour JP, Decramer S, Hatchuel Y, Jean S, Begon E, Joubert A, Merlin E, Wallach D, Meinzer U, Bourrat E. Age-specific characteristics of neutrophilic dermatoses and neutrophilic diseases in children. J Eur Acad Dermatol Venereol 2019; 33:2179-2187. [PMID: 31166045 DOI: 10.1111/jdv.15730] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 05/08/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Our suggested 'modern' concepts of 'neutrophilic dermatoses' (ND) and 'neutrophilic disease' were based on observations in adult patients and have not been studied in paediatric patients. Only a minority of ND occurs in children, and little is known about age-specific characteristics. OBJECTIVES To describe age-specific characteristics of ND in children and to study whether our suggested 'modern' classification of ND may be applied to children. METHODS We conducted a retrospective multicentre study in a French cohort of 27 paediatric patients diagnosed with pyoderma gangrenosum (PG) or Sweet's syndrome (SS). RESULTS Demographics and distribution of typical/atypical forms were similar in patients diagnosed with PG and SS. Atypical ND were more frequent in infants (90%), when compared to young children (60%) and adolescents (33%). Neutrophilic disease was observed in 17/27 patients and was most frequent in infants. Neutrophilic disease of the upper respiratory tract, as well as cardiac neutrophilic disease, was only observed in infants, whereas other locations were similarly found in infants, young children and adolescents. In infants and young children, ND were associated with a large spectrum of general diseases, whereas in adolescents associations were limited to inflammatory bowel disease and Behçet's disease. CONCLUSIONS Our study describes the concept of ND in paediatric patients and shows that they have some characteristics different from ND occurring in adults. ND occurring in infants can be associated with a large spectrum of general diseases. Occurrence of neutrophilic disease is frequent in children. Thus, ND occurring in young paediatric patients should incite clinicians to schedule complementary explorations in order to search for involvement of other organs and to rule out monogenetic autoinflammatory syndromes.
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Affiliation(s)
- M Bucchia
- Centre Hospitalier Le Mans, Service Urgences pédiatriques, Le Mans, France.,Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant (RAISE), Service de pédiatrie générale, Maladies Infectieuses et Médecine Interne, Hôpital Robert Debré, Paris, France
| | - S Barbarot
- Service de Dermatologie, CHU de Nantes - Hôtel Dieu, Nantes, France
| | - H Reumaux
- Service de Pédiatrie et médecine générale, CHRU de Lille, Hôpital Jeanne de Flandre, Lille, France
| | - M Piram
- CHU de Bicêtre, Service de Rhumatologue Pédiatrique, CEREMAIA, Le Kremlin-Bicêtre, France.,CESP, U1018 Inserm, Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - E Mahe
- Service de Dermatologie, Unité de Soutien à la Recherche Clinique, Argenteuil, France
| | - S Mallet
- Service de Dermatologie de l'hôpital de la Timone, Aix-Marseille Université, Marseille, France
| | - X Balguerie
- Clinique Dermatologique, CHU de Rouen, Rouen, France
| | - A Phan
- Service de Néphro-Rhumato-Dermatologie Pédiatrique, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Bron, France
| | - J-P Lacour
- Service de Dermatologie, Centre Hospitalier Universitaire de Nice, Nice, France
| | - S Decramer
- Centre Hospitalier Universitaire de Toulouse, Service de Néphrologie Médecine Interne Pédiatrique, Hôpital des Enfants, Centre De Référence des Maladies Rénales Rares du Sud Ouest, Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Y Hatchuel
- Service de Pédiatrie, Centre Hospitalier Universitaire de Martinique, Fort de France, France
| | - S Jean
- Service de pédiatrie Centre Hospitalier universitaire de Rennes, Rennes, France
| | - E Begon
- Service de Médecine, Centre Hospitalier René-Dubois, Cergy Pontoise, France
| | - A Joubert
- Service de Dermatologie, CHU de Nantes - Hôtel Dieu, Nantes, France
| | - E Merlin
- CHU Clermont-Ferrand, Pédiatrie Générale Multidisciplinaire, CIC INSERM 1405, Clermont-Ferrand, France
| | - D Wallach
- Médecin (honoraire) des Hôpitaux de Paris, Paris, France
| | - U Meinzer
- Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant (RAISE), Service de pédiatrie générale, Maladies Infectieuses et Médecine Interne, Hôpital Robert Debré, Paris, France.,INSERM UMR1149, Université Paris Diderot, Paris, France.,Institut Pasteur, Unité Biologie et génétique de la paroi bactérienne, Paris, France
| | - E Bourrat
- Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant (RAISE), Service de pédiatrie générale, Maladies Infectieuses et Médecine Interne, Hôpital Robert Debré, Paris, France.,Service de Dermatologie, Centre Hospitalier Universitaire Saint-Louis, Paris, France
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33
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Poline J, Fogel O, Pajot C, Miceli C, Hachulla E, Cantagrel A, Wouters C, Brissaud P, Galeotti C, Mazereeuw-Hautier J, Vignon-Pennamen M, Rybojad M, Meinzer U, Bourrat E. Manifestations cutanées du syndrome de Blau. Ann Dermatol Venereol 2018. [DOI: 10.1016/j.annder.2018.09.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ouldali N, Hugot JP, Viala J, Damir M, Martinez-Vinson C, Meinzer U. Early Arthritis Is Associated With Failure of Immunosuppressive Drugs and Severe Pediatric Crohn's Disease Evolution. Inflamm Bowel Dis 2018; 24:2423-2430. [PMID: 29788152 DOI: 10.1093/ibd/izy137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Crohn's disease (CD) is a chronic relapsing inflammatory disease. To optimize therapeutic decision making, it is essential to identify parameters that allow early prediction of a severe disease course. The aim of this study was to assess the link between arthritis and medium-term therapeutic failure in pediatric CD. METHODS We conducted a population-based cohort study with prospectively collected electronic data. To be included, patients must be younger than 17 years and have a confirmed CD diagnosed between 2005 and 2014. The primary outcome was the percentage of patients with at least 1 therapeutic failure of immunosuppressive drugs during the 2 years after the CD diagnosis, with a propensity score analysis. RESULTS We included 272 patients with CD. The median age was 12.1 years (interquartile [10.1-14.2]). Sixty-five patients (23.9%) developed arthritis, which predominantly occurred during the first year after CD diagnosis. We found a highly significant association between arthritis and therapeutic failure of immunosuppressive drugs after 2 years (OR = 6.9; 95% confidence interval [CI], 2.7-18.0; P < 0.0001; propensity score matching analysis). Arthritis was also significantly associated with introduction of biotherapy due to luminal disease 2 years after diagnosis (OR = 3.2, 95% CI, 1.8-6.0; P = 0.0001). Similar results were obtained after 4 years, and arthritis was significantly associated with a higher number of hospitalizations for luminal flare-up or complications after 4 years (OR = 2.2; 95% CI, 1.2-3.9; P = 0.007). CONCLUSIONS Arthritis was strongly associated with medium-term therapeutic failure of pediatric CD. Occurrence of arthritis early in the disease may justify closer follow-up visits or specific therapeutic management.
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Affiliation(s)
- Naïm Ouldali
- Unité d'Épidémiologie Clinique, Hôpital Robert Debré, APHP, Paris, France.,Inserm, CIC-EC 1426, Paris, France.,Service de Pédiatrie Générale, Maladies Infectieuses et Médicine Interne, Centre de Référence des Maladies Rhumatologiques et Auto-immunes Rares de l'Enfant (RAISE), Hôpital Robert Debré, APHP, Paris, France
| | - Jean-Pierre Hugot
- Service de Gastroentérologie, Centre de Références des Maladies Digestives Rares (MARDI), Hôpital Robert Debré, APHP, Paris, France.,Université Paris Diderot, INSERM UMR1149, Paris, France
| | - Jérôme Viala
- Service de Gastroentérologie, Centre de Références des Maladies Digestives Rares (MARDI), Hôpital Robert Debré, APHP, Paris, France
| | - Mohamed Damir
- Unité d'Épidémiologie Clinique, Hôpital Robert Debré, APHP, Paris, France.,Inserm, CIC-EC 1426, Paris, France
| | - Christine Martinez-Vinson
- Service de Gastroentérologie, Centre de Références des Maladies Digestives Rares (MARDI), Hôpital Robert Debré, APHP, Paris, France
| | - Ulrich Meinzer
- Université Paris Diderot, INSERM UMR1149, Paris, France.,Institut Pasteur, Unité Biologie et Génétique de la Paroi Bactérienne, Paris, France.,Service de Pédiatrie Générale, Maladies Infectieuses et Médicine Interne, Centre de Référence des Maladies Rhumatologiques et Auto-immunes Rares de l'Enfant (RAISE), Hôpital Robert Debré, APHP, Paris, France
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35
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Chbeir D, Gaschignard J, Bonnefoy R, Beyler C, Melki I, Faye A, Meinzer U. Kawasaki disease: abnormal initial echocardiogram is associated with resistance to IV Ig and development of coronary artery lesions. Pediatr Rheumatol Online J 2018; 16:48. [PMID: 30021610 PMCID: PMC6052519 DOI: 10.1186/s12969-018-0264-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 07/04/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute febrile systemic vasculitis that affects small and medium blood vessels. Intensified treatments for the most severely affected patients have been proposed recently, and the early identification of KD patients at high risk for coronary artery aneurysms (CAA) is crucial. However, the risk scoring systems developed in Japan have not been validated in European populations, and little data is available concerning the link between initial echocardiogram findings other than high z-scores and cardiac prognosis. METHODS In order to investigate whether the presence of any abnormalities, other than high z-scores in first echocardiogram, are associated with resistance to IV immunoglobulins and/or subsequent development of CAA, we retrospectively analyzed data from children diagnosed with KD between 2006 and 2016 at a tertiary Hospital in Paris, France. RESULTS A total of 157 children were included. The initial echocardiogram was performed after a median of 7 days of fever and was abnormal in 48 cases (31%). The initial presence of any echocardiographic abnormality (coronary artery dilatation, CAA, pericardial effusion, perivascular brightness of the coronary arteries, left-ventricular dysfunction and mitral insufficiency) was strongly associated with resistance to intravenous immunoglobulin (p = 0.005) and development of coronary artery lesions within the first 6 weeks of disease (p = 0.01). All patients (n = 7) with persistent coronary abnormalities at 1 year already had an abnormal initial echocardiogram. Severity scoring systems from Japan had low sensitivity (0-33%) and low specificity (71-82%) for predicting immunoglobulin resistance or cardiac involvement. CONCLUSIONS In European populations with mixed ethnic backgrounds, the presence of any abnormalities at the initial echocardiogram may contribute to early identification of patients with severe disease.
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Affiliation(s)
- Dima Chbeir
- Service de pédiatrie générale, maladies infectieuses et médecine interne, Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l’enfant (RAISE), Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris, 75019 Paris, France
- Centre de recherche sur l’inflammation, Institut National de la Santé et de la Recherche Médicale, Université Paris Diderot-Sorbonne Paris-Cité, UMR 1149, 75018 Paris, France
| | - Jean Gaschignard
- Service de pédiatrie générale, maladies infectieuses et médecine interne, Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l’enfant (RAISE), Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris, 75019 Paris, France
- Centre de recherche sur l’inflammation, Institut National de la Santé et de la Recherche Médicale, Université Paris Diderot-Sorbonne Paris-Cité, UMR 1149, 75018 Paris, France
| | - Ronan Bonnefoy
- Centre de recherche sur l’inflammation, Institut National de la Santé et de la Recherche Médicale, Université Paris Diderot-Sorbonne Paris-Cité, UMR 1149, 75018 Paris, France
- Service de cardiologie pédiatrique, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, 75019 Paris, France
| | - Constance Beyler
- Centre de recherche sur l’inflammation, Institut National de la Santé et de la Recherche Médicale, Université Paris Diderot-Sorbonne Paris-Cité, UMR 1149, 75018 Paris, France
- Service de cardiologie pédiatrique, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, 75019 Paris, France
| | - Isabelle Melki
- Service de pédiatrie générale, maladies infectieuses et médecine interne, Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l’enfant (RAISE), Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris, 75019 Paris, France
- Centre de recherche sur l’inflammation, Institut National de la Santé et de la Recherche Médicale, Université Paris Diderot-Sorbonne Paris-Cité, UMR 1149, 75018 Paris, France
| | - Albert Faye
- Service de pédiatrie générale, maladies infectieuses et médecine interne, Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l’enfant (RAISE), Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris, 75019 Paris, France
- Centre de recherche sur l’inflammation, Institut National de la Santé et de la Recherche Médicale, Université Paris Diderot-Sorbonne Paris-Cité, UMR 1149, 75018 Paris, France
| | - Ulrich Meinzer
- Service de pédiatrie générale, maladies infectieuses et médecine interne, Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l’enfant (RAISE), Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris, 75019 Paris, France
- Centre de recherche sur l’inflammation, Institut National de la Santé et de la Recherche Médicale, Université Paris Diderot-Sorbonne Paris-Cité, UMR 1149, 75018 Paris, France
- Institut Pasteur, Unité biologie et génétique de la paroi bactérienne, 75015 Paris, France
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Weill O, Decramer S, Malcus C, Kassai B, Rouvet I, Ginhoux T, Crow YJ, Rieux-Laucat F, Soulas-Sprauel P, Pagnier A, Koné-Paut I, Piram M, Galeotti C, Samaille C, Reumaux H, Lanteri A, Dubois SM, Lefebvre H, Burtey S, Maurier F, Carbasse A, Lemelle I, Meinzer U, Despert V, Flodrops H, Fabien N, Ranchin B, Hachulla E, Bader-Meunier B, Belot A. Familial and syndromic lupus share the same phenotype as other early-onset forms of lupus. Joint Bone Spine 2016; 84:589-593. [PMID: 28039062 DOI: 10.1016/j.jbspin.2016.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Studies of early-onset systemic lupus erythematosus (SLE) have identified monogenic forms of the disease. The primary objective of this study was to compare the clinical and laboratory features of the first patients included in the GENIAL/LUMUGENE cohort to those reported in previous publications. The secondary objective was to determine whether subgroups with a distinctive pattern of clinical and biological features are seen in predominantly genetic forms of SLE. METHODS GENIAL/LUMUGENE is a French nationwide study of the clinical, immunological, and genetic features of juvenile-onset SLE (clinicaltrials.gov #NCT01992666). Clinical and laboratory data from the first 64 patients younger than 18 years who were included in the first part of the study were collected retrospectively. Predefined criteria were used to divide the patients into three subgroups: syndromic SLE (n=10) and familial SLE (n=12) - both presumed to have a strong genetic component - and other forms of early-onset SLE (n=42). RESULTS The predefined criteria for identifying subgroups based on knowledge of the clinical and epidemiological features of monogenic SLE showed a significantly younger age at onset in syndromic SLE (P<0.05) and a lower frequency of joint manifestations in familial SLE. CONCLUSIONS In this study, clinical and epidemiological data alone failed to identify a specific patient subgroup characterized by the same disease presentation or progression. This result may be related to the small sample size or indicate marked heterogeneity of juvenile-onset SLE. Genetic studies using new sequencing techniques in these patients might identify genetic factors responsible for marked phenotypic variability.
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Affiliation(s)
- Olivia Weill
- Service de Médecine Interne, Néphrologie, Rhumatologie-hypertension pédiatrique, Centre de Référence des maladies Rénales Rares du Sud Ouest, SORARE, Hôpital des enfants, CHU de Toulouse, 31059 Toulouse, France
| | - Stéphane Decramer
- Service de Médecine Interne, Néphrologie, Rhumatologie-hypertension pédiatrique, Centre de Référence des maladies Rénales Rares du Sud Ouest, SORARE, Hôpital des enfants, CHU de Toulouse, 31059 Toulouse, France
| | - Christophe Malcus
- Service d'Immunologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69437 Lyon, France
| | - Behrouz Kassai
- EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacotoxicologie, CHU-Lyon, 69677 Bron, France; Université de Lyon, Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, 69622 Villeurbanne, France
| | - Isabelle Rouvet
- Centre de biotechnologie cellulaire et Biothèque, Groupe Hospitalier Est, Hospices Civils de Lyon, 69677 Bron, France
| | - Tiphanie Ginhoux
- EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacotoxicologie, CHU-Lyon, 69677 Bron, France
| | - Yanick J Crow
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; INSERM UMR 1163, Laboratory of Neurogenetics and Neuroinflammation Paris Descartes University, Sorbonne-Paris-Cité, Institut Imagine, Hôpital Necker-Enfants-Malades, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - Fredéric Rieux-Laucat
- INSERM UMR 1163, Laboratoire d'immunogénétique des maladies auto-immunes pédiatriques, Institut Imagine, 75015 Paris, France
| | - Pauline Soulas-Sprauel
- CNRS UPR 3572 "Immunopathology and Therapeutic Chemistry"/Laboratory of Excellence Medalis, Institute of Molecular and Cellular Biology (IBMC), Department of Clinical Immunology and Internal Medicine, National Reference Center for Autoimmune Diseases, Hôpitaux Universitaires de Strasbourg, UFR Sciences pharmaceutiques, Université de Strasbourg, 67200 Illkirch-Graffenstaden, France
| | - Anne Pagnier
- Service de rhumatologie pédiatrique, CHU de Grenoble, 38700 La Tronche, France
| | - Isabelle Koné-Paut
- Service de Rhumatologie Pédiatrique - Centre de Référence des maladies auto-inflammatoires de l'enfant (CeRéMAI), CHU de Bicêtre, APHP, Université Paris-Saclay, Université Paris Sud, 94276 Kremlin Bicêtre, France
| | - Maryam Piram
- Service de Rhumatologie Pédiatrique - Centre de Référence des maladies auto-inflammatoires de l'enfant (CeRéMAI), CHU de Bicêtre, APHP, Université Paris-Saclay, Université Paris Sud, 94276 Kremlin Bicêtre, France
| | - Caroline Galeotti
- Service de Rhumatologie Pédiatrique - Centre de Référence des maladies auto-inflammatoires de l'enfant (CeRéMAI), CHU de Bicêtre, APHP, Université Paris-Saclay, Université Paris Sud, 94276 Kremlin Bicêtre, France
| | | | - Héloïse Reumaux
- Unité de Néphrologie Pédiatriques, CHU de Lille, 59000 Lille, France
| | - Aurélia Lanteri
- Service de médecine interne, centre national de référence des maladies auto-immunes et systémiques rares, Hôpital Claude Huriez, FHU IMMNeNT, Université de Lille, 59037 Lille, France
| | - Sandrine Morell Dubois
- Service de médecine interne, centre national de référence des maladies auto-immunes et systémiques rares, Hôpital Claude Huriez, FHU IMMNeNT, Université de Lille, 59037 Lille, France
| | - Hélène Lefebvre
- Service de médecine interne, centre national de référence des maladies auto-immunes et systémiques rares, Hôpital Claude Huriez, FHU IMMNeNT, Université de Lille, 59037 Lille, France
| | - Stéphane Burtey
- Centre de néphrologie et de transplantation rénale, Aix-Marseille Université, Assistance publique-hôpitaux de Marseille, France
| | | | - Aurélia Carbasse
- Service de pédiatrie, CHU Montpellier, 34295 Montpellier, France
| | - Irène Lemelle
- Service d'Hémato-Onco Pédiatrie, CHRU Nancy, 54511 Vandoeuvre les Nancy, France
| | - Ulrich Meinzer
- Service de Pédiatrie Générale, Maladies Infectieuses et Médecine Interne Pédiatrique, Hôpital Robert Debré, APHP, INSERM, U1149, Centre de recherche sur l'inflammation, 75019 Paris, France
| | - Véronique Despert
- Service de Pédiatrie Grands Enfants-Adolescents, CHU Hôpital Sud, 35033 Rennes, France
| | - Hugues Flodrops
- Service de Pédiatrie, CHU La Réunion Site de Saint-Pierre, BP 350, 97448 Saint-Pierre, France
| | - Nicole Fabien
- Laboratoire d'autoimmunité, Service d'immunologie humorale, Hospices Civils de Lyon, CHLS, 69495 Pierre-Bénite, France
| | - Bruno Ranchin
- Immunologie et rhumatologie pédiatrique, Hôpital Necker, APHP, 75015 Paris, France
| | - Eric Hachulla
- Service de médecine interne, centre national de référence des maladies auto-immunes et systémiques rares, Hôpital Claude Huriez, FHU IMMNeNT, Université de Lille, 59037 Lille, France
| | - Brigitte Bader-Meunier
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; INSERM UMR 1163, Laboratory of Neurogenetics and Neuroinflammation Paris Descartes University, Sorbonne-Paris-Cité, Institut Imagine, Hôpital Necker-Enfants-Malades, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France; Service de néphrologie et rhumatologie pédiatrique, hôpital Femme-Mère-Enfant et université de Lyon 1, INSERM U1111, 69677 Bron, France
| | - Alexandre Belot
- Immunologie et rhumatologie pédiatrique, Hôpital Necker, APHP, 75015 Paris, France.
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See H, Meinzer U, Lorrot M, Faye A, Bourrat E. Acné fuminans et ostéite chronique multifocale récidivante : une entité spécifique au sein des ostéites aseptiques de l’enfant ? Ann Dermatol Venereol 2016. [DOI: 10.1016/j.annder.2016.09.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tran TA, Pariente D, Guitton C, Delwail A, Barat-Houari M, Meinzer U. Treatment of Erdheim–Chester disease with canakinumab. Rheumatology (Oxford) 2014; 53:2312-4. [DOI: 10.1093/rheumatology/keu344] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lanternier F, Barbati E, Meinzer U, Liu L, Pedergnana V, Migaud M, Héritier S, Chomton M, Frémond ML, Gonzales E, Galeotti C, Romana S, Jacquemin E, Angoulvant A, Bidault V, Canioni D, Lachenaud J, Mansouri D, Mahdaviani SA, Adimi P, Mansouri N, Jamshidi M, Bougnoux ME, Abel L, Lortholary O, Blanche S, Casanova JL, Picard C, Puel A. Inherited CARD9 deficiency in 2 unrelated patients with invasive Exophiala infection. J Infect Dis 2014; 211:1241-50. [PMID: 25057046 DOI: 10.1093/infdis/jiu412] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Exophiala species are mostly responsible for skin infections. Invasive Exophiala dermatitidis disease is a rare and frequently fatal infection, with 42 cases reported. About half of these cases had no known risk factors. Similarly, invasive Exophiala spinifera disease is extremely rare, with only 3 cases reported, all in patients with no known immunodeficiency. Autosomal recessive CARD9 deficiency has recently been reported in otherwise healthy patients with severe fungal diseases caused by Candida species, dermatophytes, or Phialophora verrucosa. METHODS We investigated an 8-year-old girl from a nonconsanguineous Angolan kindred, who was born in France and developed disseminated E. dermatitidis disease and a 26 year-old woman from an Iranian consaguineous kindred, who was living in Iran and developed disseminated E. spinifera disease. Both patients were otherwise healthy. RESULTS We sequenced CARD9 and found both patients to be homozygous for loss-of-function mutations (R18W and E323del). The first patient had segmental uniparental disomy of chromosome 9, carrying 2 copies of the maternal CARD9 mutated allele. CONCLUSIONS These are the first 2 patients with inherited CARD9 deficiency and invasive Exophiala disease to be described. CARD9 deficiency should thus be considered in patients with unexplained invasive Exophiala species disease, even in the absence of other infections.
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Affiliation(s)
- Fanny Lanternier
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163 Paris Descartes University-Sorbonne Paris Cité, Imagine Institute Department of Infectious Diseases, Necker-Enfants malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre d'Infectiologie Necker Pasteur
| | - Elisa Barbati
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163 Paris Descartes University-Sorbonne Paris Cité, Imagine Institute
| | - Ulrich Meinzer
- Department of General Pediatrics and Internal Medicine, Robert Debré Hospital, AP-HP University Paris 7 Denis Diderot, Paris Sorbonne Cité
| | - Luyan Liu
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163 Paris Descartes University-Sorbonne Paris Cité, Imagine Institute
| | - Vincent Pedergnana
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163 Paris Descartes University-Sorbonne Paris Cité, Imagine Institute
| | - Mélanie Migaud
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163 Paris Descartes University-Sorbonne Paris Cité, Imagine Institute
| | - Sébastien Héritier
- Paris Descartes University-Sorbonne Paris Cité, Imagine Institute Pediatric Hematology-Immunology Unit
| | - Maryline Chomton
- Paris Descartes University-Sorbonne Paris Cité, Imagine Institute Pediatric Hematology-Immunology Unit
| | - Marie-Louise Frémond
- Paris Descartes University-Sorbonne Paris Cité, Imagine Institute Pediatric Hematology-Immunology Unit
| | - Emmanuel Gonzales
- Pediatric Hepatology Unit, DHU Hépatinov, INSERM U757, Paris-Sud 11 University, Bicêtre Hospital, AP-HP
| | - Caroline Galeotti
- Pediatric Rheumatology Unit, Bicêtre Hospital, AP-HP, Paris Sud University, CeReMAI
| | | | - Emmanuel Jacquemin
- Pediatric Hepatology Unit, DHU Hépatinov, INSERM U757, Paris-Sud 11 University, Bicêtre Hospital, AP-HP
| | | | - Valeska Bidault
- Pediatric Surgery Unit, Bicêtre Hospital, AP-HP, Kremlin Bicêtre
| | | | - Julie Lachenaud
- Department of Pediatrics, Pontoise Hospital, Cergy Pontoise, France, EU
| | - Davood Mansouri
- Department of Clinical Immunology and Allergy, National Research Institute of Tuberculosis and Lung Diseases, Masih Daneshvari Hospital
| | - Seyed Alireza Mahdaviani
- Pediatric Respiratory Disease Research Centre, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences
| | - Parvaneh Adimi
- Department of Medical Mycology and Parasitology, Islamic Azad University Tehran Medical Branch
| | - Nahal Mansouri
- Department of Clinical Immunology and Allergy, National Research Institute of Tuberculosis and Lung Diseases, Masih Daneshvari Hospital
| | - Mahin Jamshidi
- Department of Infectious Disease, Iran University of Medical Sciences, Tehran, Iran
| | - Marie-Elisabeth Bougnoux
- Paris Descartes University-Sorbonne Paris Cité, Imagine Institute Microbiology Laboratory Fungal Biology and Pathogenicity, INRA USC 2019, Institut Pasteur
| | - Laurent Abel
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163 Paris Descartes University-Sorbonne Paris Cité, Imagine Institute St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York
| | - Olivier Lortholary
- Paris Descartes University-Sorbonne Paris Cité, Imagine Institute Department of Infectious Diseases, Necker-Enfants malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre d'Infectiologie Necker Pasteur Molecular Mycology Unit, National Reference Center for Invasive Mycoses and Antifungals, Institut Pasteur, Paris
| | - Stéphane Blanche
- Paris Descartes University-Sorbonne Paris Cité, Imagine Institute Pediatric Hematology-Immunology Unit
| | - Jean-Laurent Casanova
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163 Paris Descartes University-Sorbonne Paris Cité, Imagine Institute Pediatric Hematology-Immunology Unit St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York
| | - Capucine Picard
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163 Paris Descartes University-Sorbonne Paris Cité, Imagine Institute Pediatric Hematology-Immunology Unit Study Center for Primary Immunodeficiencies, Necker-Enfants malades Hospital, AP-HP
| | - Anne Puel
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163 Paris Descartes University-Sorbonne Paris Cité, Imagine Institute
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Meinzer U, Barreau F, Esmiol-Welterlin S, Jung C, Villard C, Léger T, Ben-Mkaddem S, Berrebi D, Dussaillant M, Alnabhani Z, Roy M, Bonacorsi S, Wolf-Watz H, Perroy J, Ollendorff V, Hugot JP. Yersinia pseudotuberculosis effector YopJ subverts the Nod2/RICK/TAK1 pathway and activates caspase-1 to induce intestinal barrier dysfunction. Cell Host Microbe 2012; 11:337-51. [PMID: 22520462 DOI: 10.1016/j.chom.2012.02.009] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 12/14/2011] [Accepted: 02/24/2012] [Indexed: 12/14/2022]
Abstract
Yersinia pseudotuberculosis is an enteropathogenic bacteria that disrupts the intestinal barrier and invades its host through gut-associated lymphoid tissue and Peyer's patches (PP). We show that the Y. pseudotuberculosis effector YopJ induces intestinal barrier dysfunction by subverting signaling of the innate immune receptor Nod2, a phenotype that can be reversed by pretreating with the Nod2 ligand muramyl-dipeptide. YopJ, but not the catalytically inactive mutant YopJ(C172A), acetylates critical sites in the activation loops of the RICK and TAK1 kinases, which are central mediators of Nod2 signaling, and decreases the affinity of Nod2 for RICK. Concomitantly, Nod2 interacts with and activates caspase-1, resulting in increased levels of IL-1β. Finally, IL-1β within PP plays an essential role in inducing intestinal barrier dysfunction. Thus, YopJ alters intestinal permeability and promotes the dissemination of Yersinia as well as commensal bacteria by exploiting the mucosal inflammatory response.
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Galeotti C, Meinzer U, Quartier P, Rossi-Semerano L, Bader-Meunier B, Pillet P, Kone-Paut I. Efficacy of interleukin-1-targeting drugs in mevalonate kinase deficiency. Rheumatology (Oxford) 2012; 51:1855-9. [DOI: 10.1093/rheumatology/kes097] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Jung C, Meinzer U, Montcuquet N, Thachil E, Château D, Thiébaut R, Roy M, Alnabhani Z, Berrebi D, Dussaillant M, Pedruzzi E, Thenet S, Cerf-Bensussan N, Hugot JP, Barreau F. Yersinia pseudotuberculosis disrupts intestinal barrier integrity through hematopoietic TLR-2 signaling. J Clin Invest 2012; 122:2239-51. [PMID: 22565313 DOI: 10.1172/jci58147] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 03/28/2012] [Indexed: 01/01/2023] Open
Abstract
Intestinal barrier function requires intricate cooperation between intestinal epithelial cells and immune cells. Enteropathogens are able to invade the intestinal lymphoid tissue known as Peyer's patches (PPs) and disrupt the integrity of the intestinal barrier. However, the underlying molecular mechanisms of this process are poorly understood. In mice infected with Yersinia pseudotuberculosis, we found that PP barrier dysfunction is dependent on the Yersinia virulence plasmid and the expression of TLR-2 by hematopoietic cells, but not by intestinal epithelial cells. Upon TLR-2 stimulation, Y. pseudotuberculosis-infected monocytes activated caspase-1 and produced IL-1β. In turn, IL-1β increased NF-κB and myosin light chain kinase activation in intestinal epithelial cells, thus disrupting the intestinal barrier by opening the tight junctions. Therefore, Y. pseudotuberculosis subverts intestinal barrier function by altering the interplay between immune and epithelial cells during infection.
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Tran TA, Koné-Paut I, Marie I, Ninet J, Cuisset L, Meinzer U. Muckle-Wells syndrome and male hypofertility: a case series. Semin Arthritis Rheum 2012; 42:327-31. [PMID: 22512814 DOI: 10.1016/j.semarthrit.2012.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 02/28/2012] [Accepted: 03/09/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Muckle-Wells syndrome (MWS) is a rare autoinflammatory disorder associated with NLRP3 gene mutations, which cause excessive caspase-1 activation and processing of interleukin (IL)-1β and IL-18. Here we investigated whether MWS disease may be associated with impaired fertility in male patients. METHODS Medical records of all male MWS patients with NLRP3 mutations followed in our tertiary center for inherited autoinflammatory diseases were reviewed retrospectively for data indicating fertility problems. RESULTS Six of 9 patients were unable to have children despite regular sexual activity during at least 2 years; 3 succeeded in having children through in vitro fertilization. Infertility was the main reason for divorce in 1 patient. Spermiogram analyses were available in 8 of the 9 patients. Oligozoospermia was observed in 5 patients and azoospermia in 3 patients. In 2 patients, treatment with IL-1-targeting drugs for 6 and 12 months, respectively, had a moderate or no effect on spermatozoa counts. In 2 patients testosterone levels were low and testosterone treatment significantly increased spermatozoa counts in 1 of them. CONCLUSIONS MWS may be associated with subfertility and infertility in male patients. Consequently, sexual health and fertility should be assessed systematically in adolescent and adult male patients. Additional studies are required to establish the frequency of subfertility in male MWS patients, to understand when subfertility occurs in the disease natural history, and, finally, to investigate whether early management with IL-1-targeting drugs, or testosterone treatment or early sperm cryo-conservation may help to allow procreation.
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Affiliation(s)
- Tu-Anh Tran
- Department of Pediatrics, Pediatric Rheumatology, Reference Center for AutoInflammatory Diseases CEREMAI, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris, Université Paris Sud, Le Kremlin-Bicêtre, France.
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Tran TA, Pariente D, Lecron JC, Delwail A, Taoufik Y, Meinzer U. Treatment of pediatric Erdheim-Chester disease with interleukin-1-targeting drugs. ACTA ACUST UNITED AC 2012; 63:4031-2. [PMID: 21898344 DOI: 10.1002/art.30638] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- T A Tran
- Hôpital Bicêtre, INSERM U1012, France
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Tran TA, Lecron JC, Pariente D, Jéru I, Delwail A, Kone-Paut I, Meinzer U. Rationale and efficacy of interleukin-1 targeting in pediatric Erdheim- Chester disease. Pediatr Rheumatol Online J 2011. [PMCID: PMC3194727 DOI: 10.1186/1546-0096-9-s1-p67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Meinzer U, Quartier P, Alexandra JF, Hentgen V, Retornaz F, Koné-Paut I. Interleukin-1 targeting drugs in familial Mediterranean fever: a case series and a review of the literature. Semin Arthritis Rheum 2011; 41:265-71. [PMID: 21277619 DOI: 10.1016/j.semarthrit.2010.11.003] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 11/02/2010] [Accepted: 11/17/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Familial Mediterranean fever (FMF) is an autosomal-recessive autoinflammatory disorder common in Mediterranean populations. FMF is associated with mutations of the MEFV gene, which encodes pyrin. Functional studies suggest that pyrin is implicated in the maturation and secretion of IL-1. The IL-1 receptor antagonist or anti-IL1 monoclonal antibody may therefore represent a new approach to treat FMF. The aim of this report was to evaluate and discuss treatment of FMF with interleukin-1 targeting drugs. METHODS Electronic mailing lists of French pediatric and adult rheumatologist associations were used to call for FMF patients treated with interleukin-1 antagonists. A search for published FMF patients treated with interleukin-1 targeting drugs was performed by screening PubMed. RESULTS Here, we report 7 cases of FMF patients treated with anakinra and/or canakinumab and discuss the clinical situations that may indicate the use of IL-1 blocking agents in FMF. The use of interleukin-1 targeting drugs was beneficial to all patients. The reasons for using interleukin-1 targeting drugs in FMF patients were as follows: (1) incomplete control of disease activity despite colchicine treatment; (2) high serum amyloid A levels despite colchicine treatment; (3) impossibility to use colchicine treatment because of severe side effects; (4) FMF in association with vasculitis. CONCLUSIONS Interleukin-1 targeting drugs may be good candidates when looking for an alternative or supplementary treatment to colchicine. These observations highlight the need for controlled trials to further evaluate the safety and efficacy of interleukin-1 antagonists in FMF patients.
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Affiliation(s)
- Ulrich Meinzer
- Division of Paediatric Rheumatology, CEREMAI, Hôpital de Bicêtre, University of Paris Sud, Le Kremlin Bicêtre Cedex, France.
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Barreau F, Madre C, Meinzer U, Berrebi D, Dussaillant M, Merlin F, Eckmann L, Karin M, Sterkers G, Bonacorsi S, Lesuffleur T, Hugot JP. Nod2 regulates the host response towards microflora by modulating T cell function and epithelial permeability in mouse Peyer's patches. Gut 2010; 59:207-17. [PMID: 19837677 DOI: 10.1136/gut.2008.171546] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Nucleotide oligomerisation domain 2 (NOD2) mutations are associated with susceptibility to Crohn's disease and graft-versus-host disease, two human disorders related with dysfunctions of Peyer's patches (PPs). In Nod2(-/-) mice transcellular permeability and bacterial translocation are increased in PPs. In this study, we show that both anti-CD4(+) and anti-interferon gamma (anti-IFNgamma) monoclonal antibodies abrogate this phenotype and reduce the expression of tumour necrosis factor (TNF) receptor 2 and the long isoform of myosin light chain kinase, thus demonstrating that immune T cells influence the epithelial functions. In turn, intraperitoneal injection of ML-7 (a myosin light chain kinase inhibitor) normalises the values of CD4(+) T cells, IFNgamma and TNFalpha. This reciprocal cross-talk is under the control of the gut microflora as shown by the normalisation of all parameters after antibiotic treatment. Toll-like receptor 2 (TLR2) and TLR4 expression were increased in Nod2(-/-) mice under basal conditions and TLR2 and TLR4 agonists induced an increased transcellular permeability in Nod2(+/+) mice. Muramyldipeptide (a Nod2 agonist) or ML-7 was able to reverse this phenomenon. It thus appears that Nod2 modulates the cross-talk between CD4(+) T cells and the epithelium recovering PP and that it downregulates the pro-inflammatory effect driven by the ileal microflora, likely by inhibiting the TLR pathways.
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Barreau F, Meinzer U, Chareyre F, Berrebi D, Niwa-Kawakita M, Dussaillant M, Foligne B, Ollendorff V, Heyman M, Bonacorsi S, Lesuffleur T, Sterkers G, Giovannini M, Hugot JP. CARD15/NOD2 is required for Peyer's patches homeostasis in mice. PLoS One 2007; 2:e523. [PMID: 17565376 PMCID: PMC1885825 DOI: 10.1371/journal.pone.0000523] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Accepted: 04/27/2007] [Indexed: 12/16/2022] Open
Abstract
Background CARD15/NOD2 mutations are associated with susceptibility to Crohn's Disease (CD) and Graft Versus Host Disease (GVHD). CD and GVHD are suspected to be related with the dysfunction of Peyer's patches (PP) and isolated lymphoid follicles (LFs). Using a new mouse model invalidated for Card15/Nod2 (KO), we thus analysed the impact of the gene in these lymphoid formations together with the development of experimental colitis. Methodology/Principal Findings At weeks 4, 12 and 52, the numbers of PPs and LFs were higher in KO mice while no difference was observed at birth. At weeks 4 and 12, the size and cellular composition of PPs were analysed by flow cytometry and immunohistochemistry. PPs of KO mice were larger with an increased proportion of M cells and CD4+ T-cells. KO mice were also characterised by higher concentrations of TNFα, IFNγ, IL12 and IL4 measured by ELISA. In contrast, little differences were found in the PP-free ileum and the spleen of KO mice. By Ussing chamber experiments, we found that this PP phenotype is associated with an increased of both paracellular permeability and yeast/bacterial translocation. Finally, KO mice were more susceptible to the colitis induced by TNBS. Conclusions Card15/Nod2 deficiency induces an abnormal development and function of the PPs characterised by an exaggerated immune response and an increased permeability. These observations provide a comprehensive link between the molecular defect and the Human CARD15/NOD2 associated disorders: CD and GVHD.
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Affiliation(s)
- Frédérick Barreau
- U843, INSERM, Paris, France
- UMR-S843, Université Paris Diderot, Paris, France
| | - Ulrich Meinzer
- U843, INSERM, Paris, France
- UMR-S843, Université Paris Diderot, Paris, France
- Service de Gastroentérologie, Hôpital R. Debré, AP-HP, Paris, France
| | - Fabrice Chareyre
- Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, France
- U674, INSERM, Paris, France
| | - Dominique Berrebi
- EA3102, Université Paris Diderot, Paris, France
- Service d'Anatomie Pathologique, Institut Pasteur de Lille, Lille, France
| | - Michiko Niwa-Kawakita
- Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, France
- U674, INSERM, Paris, France
| | - Monique Dussaillant
- U843, INSERM, Paris, France
- UMR-S843, Université Paris Diderot, Paris, France
| | - Benoit Foligne
- Laboratoire des Bactéries Lactiques et Immunité des Muqueuses, Institut Pasteur de Lille, Lille, France
| | - Vincent Ollendorff
- IMRN and UMR 1111 INRA, Faculté Saint-Jérôme, Université Paul Cézanne, Marseille, France
| | - Martine Heyman
- U793, INSERM, Paris, France
- IFR94, Université Paris Descartes, Paris, France
| | - Stéphane Bonacorsi
- EA3105, Université Paris Diderot, Paris, France
- Service de Microbiologie, Hôpital R. Debré, AP-HP, Paris, France
| | - Thecla Lesuffleur
- U843, INSERM, Paris, France
- UMR-S843, Université Paris Diderot, Paris, France
| | | | - Marco Giovannini
- Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, France
- U674, INSERM, Paris, France
| | - Jean-Pierre Hugot
- U843, INSERM, Paris, France
- UMR-S843, Université Paris Diderot, Paris, France
- Service de Gastroentérologie, Hôpital R. Debré, AP-HP, Paris, France
- * To whom correspondence should be addressed. E-mail:
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Meinzer U, Ideström M, Alberti C, Peuchmaur M, Belarbi N, Bellaïche M, Mougenot JF, Cézard JP, Finkel Y, Hugot JP. Ileal involvement is age dependent in pediatric Crohn's disease. Inflamm Bowel Dis 2005; 11:639-44. [PMID: 15973117 DOI: 10.1097/01.mib.0000165114.10687.bf] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Lymphoid follicles (LFs) have been suggested to play a role at the early stage of Crohn's disease (CD) lesions. In the small bowel, LFs are grouped, forming Peyer's patches, which develop early in fetal life, grow in size and number until puberty, and undergo involution. In contrast, colonic LFs are isolated and undergo little change during life. As a result, if LFs play a role in the occurrence of CD lesions, the distribution of ileal and colonic lesions is expected to be altered in small children. METHODS Medical records of 2 independent French (n = 136) and Swedish (n = 55) cohorts of consecutive pediatric CD were reviewed. Disease sites and age of onset were recorded, and the age-dependent probability to develop ileal lesions was computed. The CARD15/NOD2 genotype was also analyzed when available (n = 99). RESULTS The curves of disease occurrence were significantly different in case of CD with or without ileal lesions (P < 0.0001). At the age of 8 years, the probability (95% confidence interval) of small bowel involvement was 0.19 (0.07-0.39). It increased until 16 years of age to 0.61 (0.54-0.68). It was slightly higher in patients carrying 1 or more CARD15/NOD2 mutations [0.75 (0.55-0.89)] than in wild-type patients [0.46 (0.34-0.58)]. CARD15 mutations also influenced the age of onset of ileal disease (P < 0.02). CONCLUSIONS In children, ileal CD lesions are delayed compared with colonic lesions. This observation is in agreement with the previously proposed hypothesis of a pathophysiological role of Peyer's patches in ileal CD. The rarity of small bowel lesions should be a warning to be cautious when classifying chronic colitis in small children.
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Affiliation(s)
- Ulrich Meinzer
- Department of Paediatric Gastroenterology, Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris, Paris, France
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