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Introduction: False-negative findings of polymerase chain reaction (PCR) for genuine pertussis as well as the numerous atypical forms of whooping cough make it difficult to diagnose this disease in young babies., Methods: For two years, real-time PCR was performed to test for Bordetella pertussis in 86 infants younger than 6 months hospitalized for apnea or paroxysmal and/or vomiting cough and in 205 of their household contacts, whether or not they coughed., Results: Group 1 included 30 infants for whom PCR detected B. pertussis (25 of whom were also RSV+). PCR was also positive for at least one household contact in 25/30 families. This group included 16 babies with apnea and 12 who developed a whooping cough during follow-up. Group 2 comprised 12 infants whose PCR was negative while at least one household contact had positive results. Five of these infants had severe apnea and 6 developed a whooping cough. Group 3 included 44 infants (28 RSV +) for whom PCR was negative in the index case and in the household contacts: none developed a whooping cough during follow-up. Only 3 of the 54 positive household contacts had a paroxysmal cough or a typical whooping cough and 12 had no cough at all., Conclusion: Positive PCR in a household contact, symptomatic or not, is helpful for the diagnosis of atypical whooping cough in young infants.

Objective: To assess the prevalence of respiratory syncytial virus (RSV) and other important respiratory viruses in children hospitalized in a pediatric hospital in Paris (France) during a 3-year period (2001 to 2004)., Patients and Methods: The study included all patients aged 8 days to 16 years admitted from the community through emergency department with bronchiolitis, pneumonia, upper respiratory tract infection, asthma or acute isolated fever and who had nasopharyngeal samples taken for viral identification by immunofluorescence (RSV, influenza, para-influenza, and adenoviruses)., Results: A virus was found in 464 of 1208 patients with samples taken. RSV was identified in 375 patients, 74% of them younger than 6 months and diagnosed with bronchiolitis. RSV was isolated more often than any other virus, overall and for all diagnoses except "isolated fever," for which influenza was more frequent. In patients aged 24 months or older, influenza and RSV were identified at the same frequency. Overall, influenza virus was found in 53 patients, adenoviruses in 24 and para-influenza viruses in 11., Conclusion: RSV was the respiratory virus isolated most often, even in older children, during this 3-year study. The relative rarity of hospitalizations due to para-influenza viruses is characteristic of this area, compared with some other countries.

France has changed from a country where hepatitis A is endemic to one where residents are at risk of hepatitis A infection: in 20 years, the seroprevalence in 20-year-olds has fallen from 50% to less than 10%. Prophylaxis for close contacts of an index case has therefore become a major problem because their risk of hepatitis A is high. Polyvalent immunoglobulins are recommended in several countries, but no immunoglobulins are approved for this indication in France. Immunoglobulins are also expensive and only slightly efficacious. A vaccine against hepatitis A administered to young children or adolescents can break the epidemic chain and protect adults very effectively by limiting virus circulation. Many countries propose early vaccination to at-risk contacts, with vaccination generally advised within a week of the initial infectious contact. Although more specific and more plentiful data are still necessary before this recommendation can be generalized, it must be taken into account. This medical decision should thus be made on an individualized basis after discussion between the physician and family about the risk.

Objective: Procalcitonin concentration increases in bacterial infections but remains low in viral infections and inflammatory diseases. The change is rapid and the molecule is stable making it a potentially useful marker for distinguishing between bacterial and viral infections., Patients and Methods: Procalcitonin (PCT) was determined with an immunoluminometric assay on plasma collected at admission in 436 infants and children hospitalized for bacterial or viral infection. It was compared with C reactive protein, interleukin-6 and interferon-alpha measured on the same sample., Results: PCT was 41.3 +/- 77.4 micrograms/l in children with septicemia or bacterial meningitis (n = 53), 0.39 +/- 0.57 microgram/l in children with viral infection (n = 274) and 3.9 +/- 5.9 micrograms/l in children with a localized bacterial infection who had a negative blood culture (n = 109). PCT was > 1 microgram/l in 126 children with a localized or systemic bacterial infection (sensitivity 78%). PCT was < 1 microgram/l in 258 children with a viral infection (specificity 94%). For differenciation between viral and bacterial infections, CRP value > or = 20 mg/l, IL-6 > 100 pg/ml and interferon-alpha > 0 Ul/ml have 85, 48 and 76% sensitivity and 73, 85 and 92% specificity respectively., Conclusions: In this study, a PCT value of 1 microgram/l or greater had better specificity, sensitivity and predictive value than CRP, IL-6 and interferon-alpha in children for distinguishing between viral and bacterial infections. PCT may be useful in pediatric emergency room for making decision about antibiotic treatments.

Objectives: In young children with meningitis, blood or cerebrospinal fluid (CSF) analysis cannot differentiate all cases of viral meningitis (VM) from bacterial meningitis (BM). Empirical antibiotic therapy is often given. As new markers are needed, we compared serum proCalcitonin (PCT) with CSF analysis for C-reactive protein (CRP) and interleukin-6 (IL6)., Patients and Methods: PCT was measured with a chemoluminescent assay in the sera of 23 children (aged 3 months to 14 years) hospitalized for BM and in 51 patients with VM., Results: Initial CRP (mean 143.3 mg/l, range 28-351 and mean 13.9, range 1-48), CSF proteins (mean 2.2, range 0.4-4.74 and mean 0.57, range 0.12-2.72) and white blood cell count in CSF (range 240-17500 and 20-3200) in BM and VM respectively, were not sufficiently discriminative to distinguish between BM and VM. Twenty-four of the 51 patients with VM were given antibiotics. IL6 values at admission showed an overlap zone (> 100 pg/ml in 7/19 patients with VM and < 100 pg/ml in 1/8 patients with BM. PCT was discriminative in all cases: mean PCT in BM was 61 micrograms/l (range 4.8-335) and 0.33 in VM (range 0-1.7; p < 0.001). No production of PCT was detected in CSF. After antibiotic therapy, PCT decreased and reached undetectable levels after recovery., Conclusion: PCT is a sensitive and specific marker for early diagnosis of viral meningitis versus bacterial meningitis in children.

Objectives: Define a therapeutic management schema adapted to children with community-acquired pneumonia., Methods: A prospective survey was conducted in 104 children over 18 months of age with community-acquired pneumonia. The pathogen was isolated in 85% of the cases., Results: Viral infection alone was proven in 30 children (respiratory syncytial virus in 10). Pneumococci pneumonia was found in 12 patients; the isolated strains were sensitive to penicillin. Apyrexia was obtained in 11/12 cases with amoxicillin. Mycoplasma infections occurred in 42% of the cases (41 alone and in association with pneumococci in 2 cases). Pneumococci and mycoplasma infections could not be differentiated with standard radiography and laboratory tests. Initial treatment with beta lactamines was always unsuccessful in children with mycoplasma infections. Apyrexia was achieved when antibiotics were changed to macrolides., Conclusion: Since lower respiratory tract infections due to pneumococci are much more severe than those due to mycoplasma, beta lactamines should be given as first intention treatment for children over 18 months with pneumonia. Macrolides should be given in case of failure because mycoplasma would then be the most probable infectious agent.

Objectives: We performed the breath hydrogen test in children consulting for abdominal pain in order to determine the minimal quantity of lactose required to prove malabsorption with least patient incomfort and to evaluate the effect of an adapted diet in children with a positive test., Methods: The breath hydrogen test after lactose intake was performed in 109 children (51 boys, 58 girls, mean age 8.2 + 3.2 years, range 3 to 15) seen for unexplained abdominal pain. All these children had complained of abdominal pain daily for at least 6 months and no other cause could be identified. Children with acute or chronic diarrhoea or constipation were excluded. Nineteen children had been transferred from the surgery unit and 6 had been followed by the psychiatry unit. All these children drank milk regularly., Results: The diagnosis of lactose intolerance was established in 83 children (76.1%) on the basis of a hydrogen peak in the breath after lactose ingestion. One-fourth of the children were of French origin and the others had at least one grandparent who was of Mediterranean or African origin. A lactose-free diet was proposed and led to the disappearance of abdominal pain in 24% and a clear improvement in 32%., Conclusion: The breath hydrogen test is a simple non-invasive test which allows a selection of children who could benefit from a lactose-free diet although it cannot be used to predict the effect of diet.

In order to evaluate the predictive value of parasitaemia, this parameter was measured on admission in 69 Gabonese children aged from 3 to 13 years hospitalized for Plasmodium falciparum malarial attacks. Fourteen of these children had cerebral malaria, 5 had isolated convulsions and 50 had uncomplicated attacks. The parasitaemia values measured were compared with those found in asymptomatic children of the same age range carrying trophozoites. There were no significant differences in mean parasitaemia count between the 3 types of malarial attack, and only the asymptomatic carriers had significantly lower counts. However, the wide scattering of individual values within each group indicated that simple measurement of parasitaemia is not discriminative enough to predict the course of malarial attacks in children living in endemic regions. In particular, malarial attacks with very low or very high parasitaemia value are possible, but similar values are found in asymptomatic carriers.

Among 300 cases of Plasmodium falciparum malaria attacks explored in Gabon, the proportion of homozygous (SS) or heterozygous (AS) sickle-cell patients was 6.2 percent in 206 ordinary attacks and 3.2 percent in 94 cerebral malaria attacks, and 23.2 percent in the general population. On the other hand, asymptomatic carriage, as detected in 98 children by thin blood films in school screening, was as frequent in the SS or AS infantile population as in the general population. These data show that haemoglobin S protects effectively, although not entirely, against severe attacks of P. falciparum malaria. The incidence of anaemia and vaso-obstructive crisis in malaria-infested sickle-cell patients suggests that subclinical carriage of haematozoa may worsen the course of sickle-cell disease, and this must be taken into account when planning treatment.

Lactase deficient subjects, who form the bulk of the world population, absorb yogurt lactose because the bacteria used for fermentation produce beta-galactosidase. From a milk fermented by these bacteria and dried by a temperature-controlled process a power could be obtained which possess residual lactase activity but, unlike yogurt, does not need storage at low temperature. The lactose of this fermented powdered milk is perfectly absorbed, as proved by hydrogen respiratory tests performed in 35 lactose intolerant African subjects living in isolated villages. In 25 malnourished children under 3 years of age, this milk allowed renutrition without inducing diarrhoea--a result which could not have been obtained with ordinary milk in two-thirds of the cases. This type of food is potentially valuable to feed the large population of the third world.

Close interactions between salmonellae and Schistosoma intercalatum were demonstrated by a study of 118 children conducted at Libreville, Gabon. Bilharziasis, confirmed by rectal biopsy, was present in 76% of children hospitalized for typhoid-like salmonella septicaemia, as against 38% of controls of the same age living in the same district (P less than 0.001). Although the clinical symptoms were typical of typhoid fever, with stupor, myocarditis or leucopenia depending on the cases, the germs responsible in 26 out of 42 cases were salmonella species regarded as minor. Finally, the salmonella infection was clinically prolonged by bilharziasis in 1 out of 3 patients. It would therefore appear that salmonella adheres to the wall of S. intercalatum as to that of other schistosoma species, and that both infections must be treated concomitantly.

In a series of 50 mother-child pairs from Paris the titers of measles antibodies in cord blood were 1.4 times higher that those measured in the mother's blood, but this ratio was only 0.92 in 116 African mother-child pairs from Libreville (Gabon). Similarly, the ratio of immunoglobulin G levels in cord blood to those of the mother's blood was higher in Paris (1.34) than in Libreville (0.88). This limitation in active transfer of total of specific immunoglobulins is due to their high levels usual in African mothers, and this is not without repercussions on the immune defence mechanisms of African newborns.