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Background: About 10% of pediatric patients with invasive pneumococcal disease (IPD) die from the disease. Some primary immunodeficiencies (PIDs) are known to confer predisposition to IPD. However, a systematic search for these PIDs has never been carried out in children presenting with IPD., Methods: We prospectively identified pediatric cases of IPD requiring hospitalization between 2005 and 2011 in 28 pediatric wards throughout France. IPD was defined as a positive pneumococcal culture, polymerase chain reaction result, and/or soluble antigen detection at a normally sterile site. The immunological assessment included abdominal ultrasound, whole-blood counts and smears, determinations of plasma immunoglobulin and complement levels, and the evaluation of proinflammatory cytokines., Results: We included 163 children with IPD (male-to-female ratio, 1.3; median age, 13 months). Seventeen children had recurrent IPD. Meningitis was the most frequent type of infection (87%); other infections included pleuropneumonitis, isolated bloodstream infection, osteomyelitis, endocarditis, and mastoiditis. One patient with recurrent meningitis had a congenital cerebrospinal fluid fistula. The results of immunological explorations were abnormal in 26 children (16%), and a PID was identified in 17 patients (10%), including 1 case of MyD88 deficiency, 3 of complement fraction C2 or C3 deficiencies, 1 of isolated congenital asplenia, and 2 of Bruton disease (X-linked agammaglobulinemia). The proportion of PIDs was much higher in children aged >2 years than in younger children (26% vs 3%; P < .001)., Conclusions: Children with IPD should undergo immunological investigations, particularly those aged >2 years, as PIDs may be discovered in up to 26% of cases., (© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

Objective: To determine the clinical outcome of children with chronic recurrent multifocal osteomyelitis (CRMO)., Methods: We retrospectively reviewed clinical, biological and radiological data of children with CRMO at five French paediatric centres. Outcome data were obtained through review of hospital charts and questionnaires sent to all patients to assess disease activity and educational and vocational achievement., Results: Forty patients were assessed (34 females and 6 males) with a median age at diagnosis of 11.5 yrs (range 2-17). Median number of initial bony lesions was 2 at onset, and 3.5 over disease course. Median time since diagnosis was 3.5 yrs (range 0.5-15) and median duration of active disease 2.7 yrs (range 0.5-13.5). Nine (22.5%) patients had psychological or physical sequelae. Twenty-nine children (72.5%) responded to the questionnaire. Twenty-six had no physical disability as judged by the HAQ 0-1, two had moderate disability (HAQ: 1-2) and one had severe disability (HAQ: 2-3). Seventeen patients (58.6%) had active disease at follow-up (after 6 months to 15 yrs since diagnosis) and continued to have pain (median value of visual analogue scale: 10/100). CRMO had interfered with patient's education in two cases., Conclusions: Clinical outcome of children with CRMO is generally good, but a sizeable proportion of patients have active disease at follow-up, and a minority of patients can have a severe and prolonged disease course despite intensive treatments. Further studies are required to determine predictive factors for severe disease.

We describe 2 infants who developed atypical Kawasaki disease and coronary aneurysms during primary cytomegalovirus infection. These observations suggest that children with coronary aneurysms and Kawasaki-like disease should be tested for cytomegalovirus. Conversely, children with unusually severe primary cytomegalovirus infection should be tested for coronary aneurysms.

We report the first case of transmission of Panton-Valentine leukocidin-producing Staphylococcus aureus to a physician during the resuscitation of an infant with fatal pneumonia. The physician exhibited numerous furuncles. This case highlights the necessity for health care workers to protect themselves against transmission of infectious diseases from patient to care giver.

The aim of this prospective study of a population of children (age, 2-15 years) hospitalized for severe asthma was to test them for acute infection due to Mycoplasma pneumoniae and acute infection due to Chlamydia pneumoniae. Of 119 patients with previously diagnosed asthma, acute M. pneumoniae infection was found in 24 (20%) and C. pneumoniae infection was found in 4 (3.4%) of the patients during the current exacerbation. Of 51 patients experiencing their first asthma attack, acute M. pneumoniae infection was proven in 26 (50%) of the patients (P<.01) and C. pneumoniae in 4 (8.3%). In the control group of 152 children with stable asthma or rhinitis, 8 (5.2%) had M. pneumoniae infection (P<.005). Of the 29 patients experiencing their first asthma attack and infected with M. pneumoniae or C. pneumoniae, 18 (62%) had asthma recurrences but only 6 (27%) of the 22 patients who did not have such infections had asthma recurrences (P<.05). M. pneumoniae may play a role in the onset of asthma in predisposed children and could be a trigger for recurrent wheezing.

A prospective study of nasopharyngeal colonization by Streptococcus pneumoniae in the exceptional conditions of a closed community of abandoned children was done over a 1-year period; 71 children (age <24 months) were studied monthly. S. pneumoniae was isolated from 58 (81.7%), and 94.5% of the 111 isolates were resistant to penicillin. The mean rate of carriage was estimated at 57.4%, ranging from 42.8% to 70.4%. Children were sequentially colonized by a mean of 3 different isolates. The mean duration of carriage for a given isolate was approximately 2.2 months. Serotyping and molecular typing by pulsed-field gel electrophoresis showed that children were colonized by a limited number of clones belonging to only 4 serotypes and 4 pulsotypes. These clones rapidly spread in the community and colonized the children in waves, with a rapid turnover of S. pneumoniae isolates, facilitated by close contact between children.

We measured the plasma procalcitonin levels in 59 children who were admitted to the hospital because of bacterial or viral meningitis. Eighteen children with acute bacterial meningitis had elevated procalcitonin levels (mean level, 54.5 micrograms/L; range, 4.8-110 micrograms/L). The procalcitonin levels in 41 children with viral meningitis were low (mean level, 0.32 micrograms/L; range, 0-1.7 micrograms/L; P < .0001). Assay of cerebrospinal fluid (CSF) cells and proteins and serum C-reactive protein showed a zone of overlapping values between the two groups. Procalcitonin was not produced in CSF. Plasma procalcitonin levels decreased rapidly during antibiotic therapy. These data suggest that the measurement of plasma procalcitonin might be of value in the differential diagnosis of meningitis due to either bacteria or viruses.

Relapses of enteric fever induced by Schistosoma intercalatum have been observed to occur in central Africa. In Libreville, Gabon, 70 children (ages, 2.1-15.9 years) who were seronegative for human immunodeficiency virus and were hospitalized for septicemic salmonellosis underwent rectal biopsy for diagnosis of S. intercalatum infection. A nontyphoidal Salmonella species was isolated from 53 of the 70 patients: Salmonella typhimurium in 14 cases; Salmonella enteritidis in 7 cases; Salmonella galiema in 4 cases; Salmonella arizonae in 3 cases; and other species in 25 cases. Schistosomal eggs were present in the rectal mucosa of 48 (90.6%) of these 53 patients, in 11 (64.7%) of 17 patients with septicemia due to Salmonella typhi or Salmonella paratyphi, and in 21 (38.2%; P < .001) of 55 controls. Clinical symptoms were not different among patients coinfected with S. intercalatum and nontyphoidal Salmonella vs. those with enteric fever. Treatment with antibiotics induced apyrexia only after administration of antiparasitic therapy in 30 patients. These data strongly suggest interactions between S. intercalatum and Salmonella in infected children with clinically severe nontyphoidal salmonellal septicemia.

Halofantrine chlorhydrate 2 per cent suspension was given to 50 children (mean age 6.2 years in a dose of 8 mg/kg three times a day as a single day treatment. The children were born and lived in Gabon, where malaria transmission is continuous. They all had acute Plasmodium falciparum malaria. The children were kept in hospital for 5 days, and regularly followed over a 15-day period. The 50 children were cured and efficacy was evaluated as good in 44 cases, and excellent in six cases, as judged by improvement in their clinical signs and parasitaemia. Two criterias were considered in the evaluation of efficacy: clearance of parasitaemia (mean day 4), fever clearance (mean hour 24). There were two cases of persistences of parasites at day 15 with a very low parasitaemia rate. Tolerance to halofantrine was good from a clinical and biological point of view. Acceptability was excellent in all cases. Halofantrine 2 per cent suspension is a good alternative in the treatment of acute Plasmodium falciparum malaria in children, especially with the present situation of multidrug-resistant strains in Central Africa.

The aim of the study was to compare the placental transfer of tetanus toxoid antibodies (TTAB) and total IgG in Africa, where we had previously demonstrated a lack of transmission from mother to the newborn of measles antibodies. Two series of mother-child pairs, 45 in Paris and 134 in Libreville, Gabon, Central Africa, were measured after full-term pregnancies and normal deliveries. Means of ratios of cord/mother concentrations for TT AB and IgG were, respectively, 2.52 and 1.28 in Paris and 0.98 and 0.82 in Gabon. In 11 pairs from Libreville no TT AB were found in mother and cord blood, but in four other African newborns (3 per cent), the mother transmitted TT AB which were lower than protective level against tetanus. Other data (negative correlation between mother IgG and cord/mother ratio of corresponding TT AB concentrations, and better transmission of TT AB in the low range of maternal IgG) indicate that the limitation of active placental transfer of antibodies is related to the high maternal IgG level common in Africa.

In a TSH screening program for congenital hypothyroidism we detected seven newborn infants with normal plasma T4 and T3 levels but high immunoassayable TSH. Similar findings were obtained in their mothers. Serial plasma dilution curves, with and without the addition of normal rabbit serum to the samples, showed that the result of TSH assay performed with antihuman TSH rabbit antiserum was falsely elevated in mothers and infants by an interfering factor. Follow-up of the infants demonstrated that the falsely elevated plasma TSH levels returned to normal within the first 6 months of life. On the contrary, plasma TSH levels remained high in the mothers. These results suggested a placental transfer of maternal antibodies. Indeed, the analysis of the mothers anamnesis revealed that all had previously received injections of a microbial vaccine cultured on a rabbit lung-containing medium. We conclude that placental transfer of a maternal antirabbit factor may cause an artefactual hyperthyrotropinemia in the newborn and the incorrect diagnosis of neonatal hypothyroidism. This can be avoided by the addition of normal rabbit serum or immunoglobulin to the TSH RIA tubes.

Plasma testosterone was longitudinally studied during the first months of life in 7 XY infants with male pseudohermaphroditism. In two, the physiological postnatal rise of plasma testosterone was absent or blunted. A combined adrenal and testicular enzymatic defect was demonstrated in these two boys. In 5, a normal postnatal testosterone rise demonstrated a normal Leydig cell function. The longitudinal study of the physiologic postnatal rise of testosterone may be useful to distinguish secretory defects from responsiveness abnormalities thus improving the choice of gender in male pseudohermaphrodites.