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Au cours des trois dernières décennies, la plupart des initiatives politiques provenant du Québec ont eu l’effet d’accentuer le caractère distinct de cette province. Ces interventions se sont concentrées dans les domaines linguistique et constitutionnel, de telle sorte que le Québec fut proclamé « province pas comme les autres », ou plus récemment « société distincte ». Curieusement, au même moment où les politiciens québécois cherchaient la reconnaissance d’une forme de statut particulier, l...

An increasing number of travellers cross international borders and is exposed to arthropod-borne diseases. Primary care physician should not only know and give advice on preventive measures, but also estimate the risk to an individual traveller. Personal protective measures are an important and sometimes the only way to prevent arthropod-borne diseases. Personal protective measures are maximised by using an integrated approach that includes physical (e.g. clothing, bed net) and chemical barriers (e.g. repellents, insecticides).

Four studies, including two being published as an abstract, have recently demonstrated the feasibility of oral treatment of pyelonephritis in children, with no increased risk of treatment failure, early urinary tract re-infection, or renal scars. To do so, the pediatrician must ensure that: (1) the patient does not appear toxic, has no vomiting; (2) there is no known severe obstructive or refluxing uropathy and (3) parents are deemed to be adherent to the treatment. If these criteria are fulfilled, the pediatrician can start an oral treatment with a 3rd generation cephalosporine for 10 to 14 days. Ambulatory follow-up is crucial, and persistance of fever after 3 days is a reason for a new outpatient visit, additional or supplementary imaging studies (renal ultrasonography) and eventually a switch to intravenous treatment.

Four studies, including two being published as an abstract, have recently demonstrated the feasibility of oral treatment of pyelonephritis in children, with no increased risk of treatment failure, early urinary tract re-infection, or renal scars. To do so, the pediatrician must ensure that: (1) the patient does not appear toxic, has no vomiting; (2) there is no known severe obstructive or refluxing uropathy and (3) parents are deemed to be adherent to the treatment. If these criteria are fulfilled, the pediatrician can start an oral treatment with a 3rd generation cephalosporine for 10 to 14 days. Ambulatory follow-up is crucial, and persistance of fever after 3 days is a reason for a new outpatient visit, additional or supplementary imaging studies (renal ultrasonography) and eventually a switch to intravenous treatment.

Fifty years after the first report by Gasser and Gautier, hemolytic, uremic syndrome is rather rare but severe childhood disease. A recent survey demonstrates that more than 90% of the cases occurring in Switzerland are caused either by Escherichia coli that produces shigatoxin or by Streptococcus pneumoniae.

Recent developments in HIV-specific CTL quantification (staining with MHC-epitopic peptide tetramers and IFNγ production) have shed new light on human immunodeficiency virus (HIV)-specific cytotoxic T lymphocytes (CTL). One week after infection, anti-HIV CTLs quickly appear, with a weak specificity spectrum which broaden afterwards. During the asymptomatic stage, an equilibrum between host and virus exists, characterized by vigourous CTL responses (frequencies: 10-2 to 10-3 CD8 T cells) directed against all HIV proteins and poor HIV replication. The ratio anti-HIV CTL : CD4 infected cells is 10:1, thus in favour of CTL action. When HIV viral load rises up, Aids stage is reached due to either viral escape or immune system exhaustion. Highly active antiretroviral therapies permit some immune reconstitution while effector CTLs decrease. Even if it is controled. HIV is still present in « viral reservoir ».

The first part of this paper reviews: (1) the spectrum of clinical features of congenital toxoplasmosis; (2) the natural course of fetal infection; (3) the influence of antitoxoplasma therapy on the course of the disease; (4) methods for diagnosing the toxoplasma infection and assessing the severity of the disease; (5) currently used antitoxoplasma drugs and different therapeutic regimens. The second part suggests a practical approach to the problem of congenital toxoplasma infection, including diagnostic work-up, drug therapy, and follow-up. This practical approach is modulated according to the clinical syndrome in the infant and diagnostic and therapeutic considerations in the mother.