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Abstract: The potential severity of meningitis in infants and children requires an optimized initial empirical therapy, mainly based on direct cerebro spinal fluid (CSF) examination, and rapid therapeutic adaptation according to bacterial identification and susceptibility. Combination treatment including cefotaxim (300mg/kg per day) or ceftriaxone (100mg/kg per day) and vancomycine (60mg/kg per day) remains the standard first line if pneumococcal meningitis cannot be ruled out. A simple treatment with third generation cephalosporin can be used for Neisseria meningitidis or Haemophilus influenzae meningitis, aminoglycosides must be added in case of Enterobacteriacae, mainly before 3 months of age. Second line antibiotic therapy is adapted according to the clinical and bacteriological response on Day 2. When the minimal inhibitory concentration (MIC) of pneumococcal strain is less than 0.5mg/L, third generation cephalosporin should be continued alone for a total of 10 days. In other cases, a second lumbar puncture is necessary and the initial regimen, with or without rifampicin combination, should be used for 14 days. Amoxicillin during 3 weeks, associated with gentamycin or cotrimoxazole is recommended for listeriosis. [Copyright &y& Elsevier]

Abstract: Neonatal osteoarticular infections remain rare, with an estimated incidence of 1 to 3 cases per 1000 admissions to Neonatal Intensive Care Units. It usually results from bacteraemia and may thus be induced by IV catheters. More rarely it is due to direct inoculation secondary to cutaneous damage, or extension of soft tissue infection. The particularity of bone vascularization in the newborn explains the frequency of abscess formation in the periosteum or in soft tissues. The main pathogen involved is S. aureus (3/4 of cases), followed by group B streptococci and enterobacteriacae. Infection consists mainly of localised and slowly progressing abscesses. However, multifocal and severe infection is possible, in particular when caused by an IV catheter. Ultrasonography is the best initial investigation, possibly leading to surgical care. Medical treatment must include 2 synergistic antistaphyloccocal antibiotics, possibly associated with cefotaxime. The outcome is generally favorable, but orthopaedic consequences may emerge if the growth plate is involved. Rare specific causes, such as syphilis or tuberculosis, should also be evoked, but the clinical context is generally helpful for the diagnosis. [Copyright &y& Elsevier]

Abstract: Incidence of chlamydial infection depends on maternal colonization during pregnancy, which is different in each population. The trans mission is not obligatory but when present, it occurs at birth through the genital tractus. Chlamydia trachomatis infection is the first cause of neonatal conjunctivitis, with no influence of eye lotion application at birth. C. trachomatis is also responsible for interstitial pneumonia with possible consequences on the lung function. The laboratory diagnosis relies on the identification of intracellular bacteria in patient samples by the mean of culture or PCR. Systemic antibiotherapy by macrolides is always necessary, with local application in the case of conjunctivitis. The key point is the detection of colonization of pregnant women with identified risk factors. In positive case, oral treatment of both parents is recommended. [Copyright &y& Elsevier]

Summary: Objective: We evaluated the severity of influenza A(H1N1)v clinical forms among infants less than 6 months of age. This population group was considered a high-risk group, so all people around them should be vaccinated first. Patients and methods: In south-western France in Aquitaine, we collected all infants less than 6 months of age during a period between the 6th September 2009 and the 6th January 2010 with influenza A(H1N1)v confirmed by PCR. For each of them, the risk factors, clinical presentation, hospitalization, and course of, the disease were identified. We compared two groups: children under 3 months and infants aged 3–6 months. Results: We identified 74 infants. The average age was 3 months. Sixteen infants had at least 1 risk factor: 9 respiratory diseases (12%), 8 born prematurely (but there was no preterm baby under 33 weeks); one infant presented a cardiac disease, and another 1 epilepsy. Five infants showed no fever, 73% had cough, and 24% had gastro-intestinal symptoms. Infants under 3 months of age presented less cough (P <0.025) and fewer gastro-intestinal symptoms (P <0.01) than older ones. Only 5 infants needed oxygen and 4 presented pneumonia. Forty-eight infants were hospitalized, including 1 in intensive care, with a median duration of 3 days. Forty-five percent spent 2 days or less in the hospital. Infants under 3 months of age were more often hospitalized (P <0.001). Conclusions: Infants under 6 months of age did not present a severe form of influenza A(H1N1)v. Infants under 3 months of age were less symptomatic than older infants and were often hospitalized, but hospital stays were short with a good outcome. [Copyright &y& Elsevier]

Abstract: Nontuberculous mycobacterial infections are rare in immunocompetent children, and usually present as adenitis. We report a case of a 6-year-old girl with a multifocal chronic osteomyelitis and pulmonary localisation due to Mycobacterium intracellulare associated with an autosomal dominant mutation of interferon gamma receptor 1 gene (INFGR1) leading to a syndrome of mendelian predisposition to mycobacteria infections by partial deficiency of intracellular signalisation of gamma interferon. This child has been cured with anti-mycobacteria drugs and gamma interferon. This report focus on the importance of looking for a susceptibility of the host to infectious diseases, which can lead to a specific treatment. As far as we know, this is the first case described in a tropical area. [Copyright &y& Elsevier]