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Summary: A 15-month-old boy treated with amoxicillin and clavulanic acid therapy for 8 days was admitted for persistent gastroenteritis and fever. He received ceftriaxone for pneumonia modified on day 4 for cefotaxime and josamycin due to extension of alveolar lesions. On day 7, persistent fever and worsened respiratory distress led to addition of rifampicin. The child was then admitted to an intensive care unit. A hemophagocytic syndrome was suspected based on clinical signs and laboratory findings and confirmed by cytological examination of bone marrow. Adenovirus type 7 was identified by polymerase chain reaction and culture of bronchoalveolar fluid. Prognosis was good within 3 weeks. B and T immunologic evaluations were normal 5 months after the infection. This case of severe adenovirus pneumonia was associated with hemophagocytic syndrome in a child without identified primary immunodeficiency. Adenovirus type 3 and 7 are most frequently responsible for severe or fatal respiratory infections. [ABSTRACT FROM AUTHOR]

Summary: Medulloblastoma is one of the most common malignant childhood brain tumors. It is a primitive neuroectodermal tumor (PNET) and predominantly arises in the cerebellum and 4th ventricle. Most cases of medulloblastoma are sporadic, but some predisposition syndromes are known, such as SUFU and Gorlin syndromes. Most often intracranial hypertension reveals the disease typically with headache and vomiting. However, the frequent atypical presentation should not delay neuroradiological investigations. Brain and spinal MRI can establish the diagnosis of posterior fossa tumor and define the extent of the disease. CSF study completes the staging. Histologic examination of the tumor confirms the diagnosis of medulloblastoma. Patients are classified into 2 risk groups: standard-risk medulloblastoma, defined by nonmetastatic disease treated by total or subtotal tumor resection; and high-risk patients who have disseminated disease and/or residual disease. Tumor molecular genetic findings allow the use of emerging prognostic factors and may ultimately contribute to the development of targeted therapy. Current treatment in the oldest children combines surgical resection followed by radiotherapy and chemotherapy. The aim of recent studies was to increase survival and decrease sequelae by reducing CSI in older children with standard risk medulloblastoma. Treatment in younger patients is as much as possible restricted to surgery and chemotherapy. However, long-term sequelae after treatment for medulloblastoma remain frequent and the detection and treatment of those sequelae is an essential part of the follow-up of the patients. [Copyright &y& Elsevier]

L’infection bactérienne transmise par la transfusion (IBTT) est l’une des complications parmi les plus redoutées de la transfusion sanguine. Nous rapportons le cas d’une enfant de 8 ans atteinte de dyskératose congénitale, en aplasie médullaire, transfusée régulièrement en concentrés plaquettaires depuis 5 ans. Le 18/02/15, elle reçoit un CPA du fait d’une thrombopénie à 9 G/L responsable d’un syndrome hémorragique cutanéomuqueux. La malade sous antibiothérapie préventive (Sporanox ® et Bactrim ® ) est apyrétique avant transfusion (36,3 °C). Vingt-cinq minutes après le début de la transfusion apparaissent bradycardie et dyspnée puis frissons, nausées, vomissements, céphalées et hyperthermie à 40,3 °C. Un IBTT est suspecté. La patiente est transférée en service de réanimation. Les GB sont à 0,25 G/L. Le 21/02 elle est placée sous assistance circulatoire du fait d’une défaillance myocardique. Le 24/02 l’EEG est plat et la malade décède le 25/02. Les examens bactériologiques retrouvent un Citrobacter koseri dans les hémocultures de la patiente et le CPA. La donneuse est une jeune femme de 19 ans ayant déjà donné 3 fois (sang total). Les produits de ses dons ont été transfusés sans effet indésirable déclaré. L’entretien pré-don n’avait relevé aucune symptomatologie infectieuse, la numération le jour du don montrait des GB à 5,83 G/L. Les prélèvements effectués le 26/02 retrouvent au niveau de la narine de la donneuse un C. koseri de même antibiogramme que celui retrouvé dans le CPA et les hémocultures alors que les prélèvements des autres sites (selles, peau, urine) sont négatifs pour ce germe. La comparaison des souches est en cours. L’examen ORL de la donneuse est sans particularité. [ABSTRACT FROM AUTHOR]