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La bronchiolite aiguë du nourrisson est une infection respiratoire aiguë virale qui sévit par épidémies annuelles essentiellement à l'automne et en hivers. Le principal virus en cause est le virus respiratoire syncytial (VRS). Le diagnostic virologique des bronchiolites virales repose sur l'analyse d'un prélèvement respiratoire par des techniques qui détectent un large panel de virus. Ce travail a pour objectif d'identifier les virus responsables des bronchiolites aiguës dans notre contexte et d'analyser la corrélation entre le type de virus et la sévérité du tableau clinique. Il s'agit d'une étude prospective de 4 ans et 9 mois portant sur 107 nourrissons atteints de bronchiolite virale qui ont pu bénéficier de l'étude virologique. Nous avons exclu de cette étude les nourrissons ayant une maladie pulmonaire chronique du prématuré, une maladie cardiaque congénitale, une maladie génétique, une immunodéficience congénitale ou acquise ou des troubles neuromusculaires. L'âge moyen était de 7 mois avec des extrêmes allant d'un mois à 24 mois. La symptomatologie clinique était dominée par la polypnée (93 %), la toux sèche (92 %), la rhinorrhée (71 %). L'auscultation pulmonaire a objectivé des râles sibilants chez tous les patients. Dans cette série, 28 patients soit 26,1 % cas ont présenté une forme clinique sévère de bronchiolite virale. La confirmation virologique a été réalisée par la PCR multiplex chez 84 patients, le test rapide par immunochromatographie (grippe/VRS) dans 9 cas et la PCR SARS-Cov-2 chez 14 nourrissons. Six virus ont été détectés en mono-infection chez 83 patients (76,1 %). Le VRS dominait largement chez ces nourrissons hospitalisés (44,5 %) suivi par le Human Rhinovirus /entérovirus (16,8 %), le SARS-CoV-2 (16,8 %), l'Influenza A H1N1 (13,2 %), le para-influenza type 3 (6 %) et le métapneumovirus (2,4 %). Vingt-trois patients (21,4 %) avaient une co-infection virale à deux virus. Le VRS a été détecté en co-infection dans 18 cas. Un seul patient avait une co-infection à 3 virus. Dans cette série, le VRS est responsable de bronchiolites modérées (p < 0,001) et le rhinovirus seul ou associé au VRS est responsable de bronchiolites sévères (p < 0,001). Ces résultats contribueront à une meilleure compréhension de l'épidémiologie des bronchiolites virales afin de contrôler leur diffusion notamment dans les collectivités des nourrissons. Ceci grâce au développement de stratégies de prévention efficaces et d'approches thérapeutiques ciblées. Acute bronchiolitis in infants is an acute viral respiratory infection which occurs in annual epidemics mainly in autumn and winter. The main virus involved is the respiratory syncytial virus (RSV). The virological diagnosis of viral bronchiolitis is based on the analysis of respiratory using techniques that detect a wide range of viruses. The aim of this study was to identify viruses responsible for acute bronchiolitis in our context and to analyse the correlation between the type of virus and the severity of the clinical presentation. This was a prospective study of 4 years and 9 months, involving 107 infants with viral bronchiolitis who were benefited from the virological study. All patients with chronic lung disease in premature infants, congenital malformations, congenital heart disease congenital heart disease, genetic disease, congenital or acquired immunodeficiency, neuromuscular disorders. The average age was 7 months. The extremes ranged from one month to 24 months. Clinical symptoms were dominated by polypnoea (93%), dry cough (92%) and rhinorrhoea (71%). Pulmonary auscultation revealed sibilant rales in all patients in all patients. In this series, 28 patients (26.1%) presented with a severe clinical form of viral bronchiolitis. Virological confirmation was performed by multiplex PCR in 84 patients, rapid immunochromatography (influenza/RSV) in 9 cases and SARS-Cov-2 PCR in 14 infants. Six viruses were detected in mono-infection in 83 patients (76.1%). RSV predominated (44.5%), followed by Human Rhinovirus/ Entérovirus (16.8%), SARS-Cov-2 (16.8%), Influenza A H1N1 (13.2%), para-influenza type 3 (6%) and Metapneumovirus (2.4%). Twenty-three patients (21.4%) were co-infected with two viruses. RSV was detected as a co-infection in 18 cases. Only one patient had a 3-virus co-infection. In this series, RSV is responsible for moderate bronchiolitis (P < 0.001) and rhinovirus alone or associated with RSV is responsible for severe bronchiolitis (P < 0.001). These results will contribute to a better understanding of the epidemiology of viral bronchiolitis in order to control their spread, particularly in infant communities. This through the development of effective prevention strategies and targeted therapeutic approaches. [ABSTRACT FROM AUTHOR]

Abstract: A previous study showed that B:4:P1.15 was the most frequent phenotype of Neisseria meningitidis isolated in Casablanca (Morocco). To determine if there was an epidemic clone, MLST and PFGE were used to compare 13 B:4:P1.15 strains isolated from September 1999 to December 2000. MLST showed 4 Sequence Types (ST): ST-33 was the most frequent ST (9/13 strains) and 4 strains belonged to 3 newly described STs. Twelve stains belonged to ST-32 complex, and one strain presenting a new ST (ST-2502) did not belong to any known ST complex. The analysis by PFGE showed that the strains were subdivided into 7 clusters, and that there was no epidemic clone. MLST is useful for long-term epidemiological studies on N. meningitidis strains from varied geographical origins. PFGE seemed to be well adapted to the comparison of a small number of strains isolated during a short period within a defined community. [Copyright &y& Elsevier]

Abstract: Objective: The aim of this study was to identify the clinical presentations and the current antimicrobial susceptibility of Acinetobacter baumannii. Results: We identified 754 strains especially from intensive care units (50.53%) between January 2003 and December 2005. Bronchial swabs and blood culture were prevalent. High-level resistance to betalactamines was noted: 91% to cefotaxime, 50.3% to ceftazidime, and 42.6% to imipenem. Aminoside resistance varied from 17.9% for netilmicine to 72.1% for gentamycin. The resistance rate to ciprofloxacine was 65.8%, and to trimethoprime–sulfamethoxazole 75.8%. In intensive care units, the antimicrobial resistance rate of A. baumannii was higher (p <0.05). Conclusion: The resistance of A. baumannii to current antibiotics is alarming especially in intensive care units. An effective strategy against nosocomial infection is still necessary. [Copyright &y& Elsevier]

Ecthyma gangrenosum (EG) is a rare, invasive cutaneous infection caused by Pseudomo- nas aeruginosa in the majority of cases. EG typically affects immunocompromised patients. The disease may affect patients of any age, although it is commonly reported in infants and elderly patients due to underdeveloped or compromised immune system. We report a case of a previously immunocompetent infant who developed extensive perineal EG complicated by Pseudomonas sepsis after circumcision. Our case is exceptional as it reports a case of ecthyma gangrenosum in a previously healthy infant with three risk factors (recent antibiotic therapy, transient neutropenia and circumcision-induced skin breach). [ABSTRACT FROM AUTHOR]

Objectives: To determine antibiotic susceptibility of community-acquired respiratory tract infection (CA-RTI) isolates of Streptococcus pneumoniae and Haemophilus influenzae collected in 2015–18 from Tunisia, Kenya and Morocco. Methods: MICs were determined by CLSI broth microdilution and susceptibility was assessed using CLSI, EUCAST (dose-specific) and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. Results: S. pneumoniae isolates from Tunisia (n = 79), Kenya (n = 44) and Morocco (n = 19) and H. influenzae isolates (n = 74) from Tunisia only were collected and analysed. Low antibiotic susceptibility was observed in S. pneumoniae from Tunisia, with >90% susceptible only to the fluoroquinolones (all breakpoints), penicillin (CLSI IV and EUCAST high-dose) and ceftriaxone (CLSI, EUCAST high-dose and PK/PD breakpoints). In addition, isolate susceptibility in Kenya was >90% to amoxicillin and amoxicillin/clavulanic acid (CLSI and PK/PD breakpoints). Antibiotic activity was highest in Morocco, where ≥89.5% of pneumococci were susceptible to most antibiotics, excluding trimethoprim/sulfamethoxazole (68.4% by CLSI or PK/PD and 79%–84.2% by EUCAST), macrolides (79%–84.2% by all breakpoints) and cefaclor (0% by EUCAST and 52.6% by PK/PD). The majority (≥86.5%) of H. influenzae isolates from Tunisia were susceptible to most antibiotics by all available breakpoints, except ampicillin and amoxicillin (almost one-third were β-lactamase positive), trimethoprim/sulfamethoxazole (51.4%–56.8%), cefaclor (1.4% by PK/PD), cefuroxime (4.1% by EUCAST), macrolides (1.4%–2.7% by PK/PD) and cefdinir (66.2% by PK/PD). The application of different EUCAST breakpoints for low and higher doses for some of the antibiotics (amoxicillin, amoxicillin/clavulanic acid, ampicillin, penicillin, ceftriaxone, clarithromycin, erythromycin, levofloxacin and trimethoprim/sulfamethoxazole) allowed, for the first time in a SOAR study, the effect of raising the dosage on susceptibility to be quantified. Conclusions: Low antibiotic susceptibility was observed in S. pneumoniae from Tunisia, but susceptibility was higher in isolates from Kenya and highest in those from Morocco. H. influenzae from Tunisia were highly susceptible to most antibiotics. These factors are important in decision making for empirical therapy of CA-RTIs. [ABSTRACT FROM AUTHOR]

1. The aim of the experiment was to determine the occurrence of genes encoding aminoglycoside-modifying enzymes (AMEs) in Escherichia coli isolates recovered from chicken meat. 2. Antibiotic sensitivity was tested using the disc diffusion test. AMEs and virulence profile were determined by PCR/sequencing. 3. Out of 195 meat samples collected, 185 (95%) isolates were identified as E. coli. Disc diffusion showed a resistance value of 22% (n = 42) for at least one of the antibiotic aminoglycosides (AGs) tested (tobramycin, gentamycin, amikacin and kanamycin). PCR screening showed the presence of three classes of AMEs, namely, aac(3)-II (12%), aac(6ʹ)-Ib (7%) and aac(2ʹ)-Ia (5%). Eight of the 42 isolates were positive for the stx1 and sxt2 genes and were defined as Shiga toxin-producing E coli., while the eae gene was positive in one strain. Among the 42 isolates, group A was the predominant phylogenetic identified (76%), followed by group D (21%). One isolate belonged to subgroup B23. 4. The results suggested that chicken meat could be an important reservoir of AMEs, and pose a potential risk by dissemination of resistance to humans through the food chain. [ABSTRACT FROM AUTHOR]

In Morocco, 13-valent pneumococcal conjugated vaccine (PCV) was introduced in the childhood immunization program in October 2010 and changed to PCV-10 in July 2012. The purpose of this study was firstly to determine the prevalence of pneumococcus carriage in a population of febrile infants in Marrakesh and secondly, to investigate the risk factors for carriage and the distribution of circulating serotypes. This prospective study was conducted from February to June 2017, in the pediatric emergency department of the Mother and Child Hospital of Mohammed VI University Hospital Centre (UHC) in Marrakesh. At total of 183 febrile infants, aged 2–18 months, were enrolled in this study and were swabbed for nasopharyngeal carriage. Pneumococci were cultured, identified, serotyped, and tested for penicillin susceptibility. Demographic data and risk factors for carriage were collected. The statistical analyses performed were the following: the analysis of the risk factors using logistic regression, the estimation of serotype diversity with the Simpson index, and the Chi2 test to compare serotype distribution in the prevaccination (a cohort of 660 healthy children, less than 2 years old, in the Marrakesh region, in 2008–2009) and postvaccination periods. The prevalence of Streptococcus pneumoniae carriage was 68.3%. Of the 183 infants enrolled in this study, 111 had received at least one dose of PCV-10. Colonization by vaccine serotype among febrile children was related to incomplete vaccination status. In total, vaccine serotypes accounted for 6.4% (n = 8): 19F (n = 2), 1 (n = 2) and one strain for each of the following serotypes: 14, 23F, 6B, and 9 V. Non-vaccine and nontypeable strains presented 63.2% and 23.2%, respectively, with dominance of serotypes 6A (6.4%), 15A/15F (5.6%), 20, 22F/22A, 23B, and 11A/11D with a prevalence of 3.2%. The rate of pneumococcus strains with reduced susceptibility to penicillin was 33.6%, of which 90.2% were non-vaccine serotypes and nontypeable strains. Serotype diversity increased in the postvaccination period and the effectiveness of PCV-10 against vaccine serotypes was estimated at 89.6%. An important change in the distribution of vaccine and non-vaccine serotypes was observed after the introduction of the PCVs. In fact, the prevalence of vaccine serotypes decreased significantly while non-vaccine serotypes emerged. These results underscore the importance of maintaining close and prolonged surveillance of serotype distribution to monitor the dynamics of nasopharyngeal pneumococcal carriage. [ABSTRACT FROM AUTHOR]

There is increasing interest in periprostatic fat and its influence on prostate cancer aggressiveness. In vitro data suggest that adipose stromal/stem cells ( ASCs) can increase production of cytokines and growth factors resulting in invasive growth and metastasis in prostate cancer. The objective of the study was to determine the interaction between 5α-reductase inhibitors (5 ARIs) and periprostatic adipose tissue ( PPAT) and factors of prostate cancer aggressiveness. In this retrospective study, we identified 61 patients treated with 5 ARIs for a period of ≥12 months before undergoing radiation therapy (brachytherapy or external beam radiotherapy). The control group consisted of 117 patients without any exposure to 5 ARIs. Prior to being treated, all patients underwent abdominal computed tomography ( CT). To measure PPAT, we defined the fat pad anteriorly to the prostate, as well as the intra-abdominal visceral adipose tissue (VAT) and subcutaneous tissue ( SAT) at the level of L4/L5. All contours were performed manually. These adipose tissue measurements were correlated with the Cancer of the Prostate Risk Assessment ( CAPRA) score using Pearson correlation coefficient. Differences in fat contents were evaluated using Student's t-test. Median time on 5 ARIs for the 61 patients was 12 months (range 12-96). Patient on 5 ARIs had a significantly ( p < 0.001) smaller PPAT (0.4, SD 0.5) than patients without a 5 ARI (0.6 cc, SD 0.4). There was no significant correlation between the CAPRA score and fat measurements when adjusted for 5 ARI use ( p = 0.18). In non-5 ARI users, BMI was not correlated with PPAT but was correlated with SAT and VAT volume and its density. There were no significant differences in diabetics ( p = 0.3), metformin users ( p = 0.4) or statin users ( p = 0.09) between both groups. 5 ARIs taken for at least 12 months induce changes in PPAT volume. Whether these changes or the extent of changes will have an influence on outcome remains unknown. [ABSTRACT FROM AUTHOR]

L'incidence des infections invasives à Streptococcus pyogenes , autrement appelé streptocoque du groupe A (SGA) est en nette augmentation ces dernières années. Néanmoins, la méningite à SGA reste une entité rare et même exceptionnelle chez l'enfant mais de rares cas ont été décrits dans la littérature. À travers ce travail, nous rapportons le cas d'une méningite à streptocoque du groupe A chez un enfant âgé de 22 mois diagnostiqué au laboratoire de microbiologie, virologie et hygiène hospitalière du centre hospitalier universitaire (CHU) Ibn Rochd de Casablanca. Les données cliniques, bactériologiques et le pronostic sont mises en exergue dans ce travail. The incidence of invasive infections with Streptococcus pyogenes , otherwise known as group A Streptococcus (GAS), has increased significantly in the last few years. Nevertheless, GAS meningitis is still a rare and even exceptional disease in children, but rare cases have been described in the literature. Through this work, we report the case of group A streptococcal meningitis in a 22-month-old child diagnosed at the microbiology, virology and hospital hygiene laboratory of the Ibn Rochd University Hospital Centre (UHC) of Casablanca. Clinical, bacteriological and prognostic data are highlighted in this work. [ABSTRACT FROM AUTHOR]

Objectif du travail : décrire le profil épidémiologique, clinico-bactériologique et évolutif des méningites bactériennes notamment après introduction du vaccin anti-pneumococcique. Matériel et méthodes : il s’agit d’une étude rétrospective de 245 cas colligés à l’hôpital d’enfant de Casablanca entre janvier 2009 et décembre 2012. Résultats: Nos patients étaient âgés entre 1mois et 14ans. 73% d’entre eux étaient âgés de moins de 5 ans. L’agent causal a été identifié dans 49,8% des cas ; Neisseria meningitidis(NM) en a représenté63,9% des cas suivi du Streptococcus pneumonia(SP) avec 19.6% des cas. Les bacilles Gram négatif ont représenté 7,3% des cas et Haemophilus influenza(Hib) 4,9%. La sensibilité a été testée chez 17cas de SP dont 47% était résistants. Avant 2012, les sérogroupes 19, 23, 14 et 6 ont représenté 60% des SP. En 2013.18,36% des méningites se sont compliquées. Le pneumocoque était le plus pourvoyeur de complications avec une nette prédominance des complications suppuratives (14,6% des complications). Le taux de mortalité a atteint seulement 2% des cas. Conclusion :Cette étude permet de discuter l’impact de la vaccination sur le profil bactériologique des méningites purulente et souligne l’urgence de l’introduction du vaccin anti NM au Maroc. [ABSTRACT FROM AUTHOR]

Summary: The objective of our study was to determine the Incidence of nosocomial bacterial infections in a neonatal intensive care unit and to describe and identify the factors associated with their occurrence. Subjects and methods: We led a cohort study concerning newborn infants old from 0 to 28days, were hospitalized 48hours or more in the neonatal intensive care unit, University Hospital Ibn Rochd, Casablanca (Morocco), from December 1st, 2010 until November 30th, 2011. Two distinct populations were defined: group 1 (infected neonates), and group 2 (non-infected neonates). Results: We identified 35 episodes of nosocomial infections. The incidence and the density incidence rates of nosocomial bacterial infections were 7.5% and 7.1 per 1000patient-days, respectively. Two types of infection were found: pneumonias (40%) and bloodstream infections (confirmed and clinical sepsis) represented 31.4%. Bloodstream infections and pneumonias had an incidence rate of 3.1% and 2.4%, respectively. The most frequently isolated pathogens were Gram Negative Bacilli (51.5%), with Klebsiella pneumonia isolates accounting for 37%. These bacteria were isolated throughout the study year. The univariate analysis of risk factors demonstrated that the odds ratio for nosocomial infection was significantly related to umbilical vein catheterization (OR 21.44) .The odd ratio for artificial ventilation was 15.05 (OR 15.05). The isolated risk factors were: an age lower than 33 weeks (OR=12.5); a birth weight less than 1500g (OR=12.06), compared to non-infected childs. The length of hospital stay, was significantly longer in nosocomial infected patients (20±10.79days versus 9.68±5.9days;<0.0001). Mortality associated with nosocomial infection was 28.5% versus 2.5% (P ≤0.001). Conclusion: The nosocomial infections are dominated by pneumonias and bloodstream infections due to Gram Negative Bacilli. Factors associated with infections were identified. [Copyright &y& Elsevier]

Abstract: An increased incidence and severity of invasive group A streptococcus (GAS) infections over the past decade have been reported by several authors, but GAS remains an uncommon cause of bacterial meningitis. The aim of this study was to describe and analyze the clinical and biological data of GAS meningitis by reporting 10 new cases of pediatric GAS meningitis and making a literature review. The mean age of patients, seven girls and three boys, was 3 years. There was a history of preexisting or concomitant community-acquired infection in five patients over 10. The outcome was fatal in two cases. All patients received an initial empirical antimicrobial therapy with a third generation cephalosporin switched in six cases to amoxicillin. The prognosis for this type of streptococcal meningitis is usually good, but death may occur even in children without any identified risk factor for severe infection. [Copyright &y& Elsevier]

Abstract: Objectives: The authors had for aim to assess the local epidemiology, antibiotic resistance, and molecular typing of expanded spectrum betalactamase producing Klebsiella, Enterobacter, and Serratia (ESBL KES). Materials and methods: Two hundred and seven strains of the KES group were isolated in the microbiology laboratory of the Annaba Ibn Rochd hospital in 2009. The antibiotic resistance (diffusion method and MIC) was tested and ESBL detection was performed as recommended by the Clinical Laboratory Standard Institute (CLSI). The characterization of genes for resistance to β-lactams (CTX-M-1, TEM, and SHV) and AmpC cephalosporinase (DHA-1) was performed by polymerase chain reaction. The epidemiological relationship among identified strains was analyzed by Pulsed Field Gel Electrophoresis (PFGE). Genetic transfers were performed by conjugation using sodium azide resistant Escherichia coli K12J5 as recipient strain. Results: The overall incidence of ESBL KES was 31.4% (65/207) distributed as follows: 17.4% of Klebsiella spp., 7.2% Enterobacter spp., and 6.8% Serratia marcescens. The β-lactamase CTX-M 1 types were predominant (88%), followed by TEM (36.5%), and SHV (31.1%). Twenty-three strains expressed at least two bla genes. DHA-1 type cephalosporinase was found in 4 E. cloacae associated with CTX-M-1. Several epidemic clones were determined. Conjugation experiments showed that bla CTX-M , bla TEM , and bla SHV were carried by conjugative plasmids of high molecular weight (≥125kb). Conclusions: This study revealed a high frequency of ESBL KES with a predominance of CTX-M-1. This high rate of ESBLs could be due to a clonal spread and the emergence of new epidemic clones. [Copyright &y& Elsevier]

Objectifs Identifier les caractéristiques des infections à Serratia Marcescens. Proposer une stratégie de gestion d’épidémie. Méthodes Etude rétrospective d’infections nosocomiales à Serratia Marcescens de septembre à Octobre 2013 au servicede neonatologie de l’hôpital d’enfant de Casablanca. Des prélèvements dans l’environnement hospitalier et chez le personnel ont été réalisés. Résultats Neuf cas ont été enregistrés,7 inborn et 2 outborn. Quatre nouveaux- nés étaient des prématurés dont trois avaient un poids inférieur à 2000g. Sept nouveaux-nés étaient sous antibiothérapie. L’hémoculture initiale était stérile chez tous les cas. Le délai moyen d’apparition de l’infection nosocomiale était de 5 jours. Le mode de révélation était un choc septique dans 5cas, des convulsions chez 2 cas, et un échec de déventilation chez deux malades. Neuf cas de bactériémies et deux cas de méningites étaient rapportés. Toutes les souches ont présenté le même antibiotype. La durée moyenne d’hospitalisation était de 20 jours. Le taux de mortalité était de 54%. Aucune source de contamination n’a été retrouvée. Conclusions L’isolement technique et géographique des cas infectés, la limitation du nombre d’hospitalisation, la sensibilisation du personnel soignant ont permis la maitrise de diffusion du germe. [ABSTRACT FROM AUTHOR]

L’infection urinaire (IU) est une pathologie fréquente en pédiatrie et continue à poser des difficultés diagnostiques et de suivi surtout chez le nourrisson. L’objectif de ce travail est de tracer le profil épidemio-clinique et bactériologique des premiers épisodes d’IU et de déterminer la rentabilité des explorations radiologiques systématiques. Nous rapportons une étude rétrospective de 100 cas ; menée sur une période d’une année du 1er janvier au 31 décembre 2006 ; Les dossiers retenus étaient ceux des nourrissons (30 j – 24 mois) hospitalisés pour un premier épisode d’infection urinaire ; confirmée par un examen cytobactériologique des urines (ECBU) comportant une leucocyturie significative (supérieure à 104 germes/ml) ± la présence d’un germe pathogène. Notre série comporte 55 filles et 45 garçons. L’âge moyen est de 8 mois. Le motif d’hospitalisation était une fièvre aigue sans orientation clinique dans 43 cas (FASOC), une convulsion fébrile dans 14 cas et une fièvre prolongée dans 13 cas, 30 patients avaient présenté des signes digestifs à type de douleur abdominale, diarrhée et/ou vomissement alimentaires dont 7 étaient en état septique et 6 présentaient une déshydratation aigue tableau « C ». Sur le plan biologique tous les malades avaient une CRP positive (moyenne de 103,2 mg/l), et une hyperleucocytose moyenne 19743/mm3. Nous avons noté 27 % de leucocyturie sans germe. Les germes isolés étaient l’Escherichia coli dans 55 cas (75,34 %), le Klebsiella pneumoniae dans 10 cas (13,7 %) ; le Proteus mirabilis dans 6 cas (8,2 %) et le staphylocoque aureus dans 2,7 %. Tous les germes étaient sensibles aux céphalosporines de 3e génération (C3G) et aux aminosides, cependant 61,64 % étaient résistants à la pénicillineA ; 39,72 % l’étaient à l’association amoxicilline + acide clavulanique 35,61 % au cotrimoxazol. 58 % ont été traités par ceftriaxone-aminoside et (42 %) par la céftriaxone. Une échographie rénale systématique chez tous nos patients a montré une dilatation pyélocalicielle dans 18 %. La cystographie rétrograde a été réalisée chez 14 patients et a révélé un RVU grade 3-4 dans 2 cas. [Copyright &y& Elsevier]