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Background Despite vaccination programs, Streptococcus pneumoniae remains among the main microorganisms involved in bacterial pneumonia, notably in terms of severity. The prognosis of pneumococcal infections is conditioned in part by the precocity of the diagnosis. The aim of this study was to evaluate the impact of a Rapid Diagnostic Test (RDT) targeting cell wall polysaccharide of Streptococcus pneumoniae and performed directly in respiratory samples, on the strategy of diagnosis of respiratory pneumococcal infections in children. Results Upper-respiratory tract samples from 196 children consulting at hospital for respiratory infection were tested for detecting S. pneumoniae using a newly-designed RDT (PneumoResp, Biospeedia), a semi-quantitative culture and two PCR assays. If positive on fluidized undiluted specimen, the RDT was repeated on 1:100-diluted sample. The RDT was found highly specific when tested on non-S. pneumoniae strains. By comparison to culture and PCR assays, the RDT on undiluted secretions exhibited a sensitivity (Se) and negative predictive value (NPV) of more than 98%. By comparison to criteria of S. pneumoniae pneumonia combining typical symptoms, X-ray image, and culture ≥107 CFU/ml, the Se and NPV of RDT on diluted specimens were 100% in both cases. Conclusions In case of negative result, the excellent NPV of RDT on undiluted secretions allows excluding S. pneumoniae pneumonia. In case of positive result, the excellent sensitivity of RDT on diluted secretions for the diagnosis of S. pneumoniae pneumonia allows proposing a suitable antimicrobial treatment at day 0.

International audience; Excessive admissions at the Emergency Department (ED) is a phenomenon very closely linked to the propagation of viruses. It is a cause of overcrowding for EDs and a public health problem. The aim of this work is to give EDs' leaders more time for decision making during this period. Based on the admissions time series associated with specific clinical diagnoses, we will first perform a Detrended Fluctuation Analysis (DFA) to obtain the corresponding variability time series. Next, we will embed this time series on a manifold to obtain a point cloud representation and use Topological Data Analysis (TDA) through persistent homology technic to propose two early real-time indicators. One is the early indicator of abnormal arrivals at the ED whereas the second gives the information on the time index of the maximum number of arrivals. The performance of the detectors is parameter dependent and it can evolve each year. That is why we also propose to solve a bi-objective optimization problem to track the variations of this parameter.

Objectives This prospective study performed in the paediatric emergency department of the University Hospital of Saint-Etienne aimed to measure the impact of the 24/7 bedside use of the Veritor™ System (Becton Dickinson) on the reduction of supplementary investigations, hospital stay and antimicrobial use. Methods Influenza virus A and B antigens were detected with a rapid influenza digital immunoassay (DIA) on nasopharyngeal aspirates (NPAs) sampled from the children consulting at the paediatric emergency department between January and March 2016 for influenza-like illness. The same NPA was tested by immunofluorescence and/or molecular routine assays. Before performing the DIA, the clinician filled in a questionnaire listing the tests that he/she would have prescribed in the absence of the rapid testing. The prescription of complementary investigations, antimicrobial treatments and hospital stay were also compared to those of the 3 previous years. Results A total of 514 children with flu-like symptoms were included. The use of the DIA at bedside decreased the prescription of blood puncture by 47.9% (21.2% to 6.6%), of chest X-rays by 69.0% (33.3% to 10.3%), of lumbar puncture by 77.8% (7.0% to 1.6%), of urine culture by 79.2% (23.3% to 4.9%), of antibiotic treatments by 70.1% (16.9% to 5.1%), and of hospital stay by 25.0% (27.2% to 20.4%), resulting in a reduction of medical costs estimated to more than €69 000 in a season. Conclusions In addition to delivering a rapid aetiological diagnosis, this strategy saves medical costs and favours an antimicrobial stewardship strategy. However, further prospective studies are needed to confirm our findings.

Pain sensation is characterized by abrupt changes in central nervous system activity producing autonomic reactivity. While clinical hypnosis has demonstrated its benefits for children in pain management, it is not clear whether hypnosis modulated autonomic pain response in children in clinical conditions. Here, we studied autonomic responses under hypnosis to sutures in pediatric emergencies. For that, 42 children (mean age: 6.5 years, range 1.5 to 13) were divided into two groups consecutively (hypnosis and control groups), according to their choice. Time-frequency analysis was applied on RR intervals (heart rate interbeat intervals, or RRI) to estimate parasympathetic reactivity based on high frequency power (HF) and the Analgesia Nociception Index (ANI®) and on sympathetic reactivity (low frequency power [LF]) and LF/HF ratio). We observed that RRI and LF/HF ratio varied according to suture and hypnosis (

This study aims to evaluate the analytical performance of the BD Veritor™ rapid diagnostic assays (RDTs) for respiratory syncytial virus (RSV) and influenzaviruses when performed 24/7 at bedside by nurses in the pediatric emergency department (PED). The study was performed between 14/10/2015 and 19/03/2016 on nasopharyngeal aspirates (NPAs) collected from children consulting at the PED of the University Hospital of Saint-Etienne for bronchiolitis (RSV detection) or flu-like syndrome (influenzaviruses A/B detection). NPAs were tested 24/7 at the PED with the RDT and then sent to the Infectious Agents Department for routine analyses, first by immunofluorescence assay (IFA), then by nucleic acid amplification test (NAAT) considered as the gold standard in case of discrepancy between RDT and IFA results. For RSV detection, 205 NPAs was analyzed; the overall concordance between RDT and routine assays was of 97.6% (200/205). The sensitivity (Se), specificity (Sp), negative predictive value (NPV) and positive predictive value (PPV) were of 97.6% (160/164), 97.6% (40/41), 90.9% (40/44) and 99.4% (160/161), respectively. A total of 419 NPA was tested for influenzaviruses. For influenzavirus A, the overall concordance was of 98.8% (414/419); Se, Sp, NPV and PPV were of 100% (41/41), 98.7% (373/378), 100% (373/373) and 89.1% (41/46), respectively. For influenzavirus B, the overall concordance was of 97.9% (410/419); Se, Sp, NPV and PPV were of 96.6% (172/178), 98.8% (238/241), 97.5% (238/244) and 98.3% (172/175), respectively. Due to their excellent performances and their easy handle by non-laboratory personnel, these RDTs can be warmly recommended as point of care assays at the PED.

Mobile phones (MPs) of healthcare workers (HCWs) may represent an important source of transmission of infectious agents. This longitudinal study documents the contamination of these tools. Ten MPs handled by senior pediatricians were sampled once a week during 23 weeks in three pediatric wards of the University Hospital of Saint-Etienne, France. Cultures were performed for bacteria and multiplex PCR assays for a panel of respiratory and enteric viruses. A questionnaire on hygiene habits regarding phoning and care was filled-in by pediatricians before and after the study. From a total of 230 samples, 145 (63%) were contaminated by at least one pathogen. The MPs from emergency departments were the most impacted. Viruses were detected in 179 samples, bacteria were isolated in 59 samples. Contamination increased during the winter epidemic peak. A cross-contamination by Paracoccus yeei between hands and MPs of different HCWs was demonstrated. The communication of the study results influenced the hygiene behaviors. This study highlights the contamination of MPs by pathogens that are resistant in the environment, and its sustainability along the winter season. The role of MPs as vectors of nosocomial infection needs to be better investigated.

Contrast-induced acute kidney injury (CI-AKI) is a common pathology among adult patients, with an incidence ranging from 3–25 % depending on risk factors. Little information is available regarding CI-AKI incidence, risk factors, and prognostic impact in the pediatric population. We performed a retrospective study of pediatric patients who underwent computed tomography (CT) scan with iodinated contrast media injection between 2005 and 2014 in five pediatric units of a university hospital. CI-AKI was defined according to Kidney Disease/Improving Global Outcomes (KDIGO) criteria. Of 346 identified patients, 233 had renal function follow-up and were included in our analyses. CI-AKI incidence was 10.3 % [95 % confidence interval (CI) 6.4–14.2 %]. CI-AKI was associated with 30-day unfavorable outcome before (45.8 % vs. 19.7 %, P = 0.007) and after [odds ratio (OR) 3.6; 95 % CI 1.4–9.5] adjustment for confounders. No independent risk factors of CI-AKI were identified. CI-AKI incidence was as high as 10.3 % following intravenous contrast media administration in the pediatric setting. As reported among adults, CI-AKI was associated with unfavorable outcome after adjustment for confounders. Although additional studies are needed in the pediatric setting, our data suggest that physicians should maintain a high degree of suspicion toward this complication among pediatric patients.

Emergency Departments (ED) of hospitals are greatly impacted by winter epidemics of respiratory diseases. To detect the underlying overcrowding, it is essential to study patient flow. In this paper we propose to model the admission flow corresponding to clinical diagnoses encoded with ICD-10 which are more likely linked with respiratory diseases. To achieve this, clustering algorithms are applied on time evolving diagnoses in the adult ED of Saint-Etienne and benchmarked regarding a time series of laboratory-confirmed influenza data. For both K-Means and Hierarchical algorithms, the cluster containing the laboratory-confirmed series is composed of ICD-10 codes of diagnoses representing respiratory diseases and diseases linked with cardiac disorders, showing that these diseases present similar variations overtime. The information contained in such a cluster makes it possible to plot the average number of arrivals of these diagnoses overtime and the average length of stay of the patients in the ED who only have one or several of these diagnoses. Such an acknowlegdement about its patient flow will allow an ED staff to detect the underlying overcrowding.

Resume Introduction Le scorbut est la forme classique et grave de la carence majeure en vitamine C. Cette affection est devenue exceptionnelle chez l’enfant dans les pays industrialises. Observations Nous rapportons le cas de deux garcons presentant des douleurs osseuses associees a une gingivite hemorragique et, pour l’un d’eux, a un purpura perifolliculaire des membres inferieurs. Les enfants avaient un regime alimentaire desequilibre. Le scorbut s’associait a une carence en vitamine D et en fer. Les anomalies dermatologiques et radiologiques etaient caracteristiques et l’evolution a ete rapidement favorable apres supplementation. Discussion De telles presentations dermatologiques ou rhumatologiques typiques doivent faire evoquer le diagnostic de cette maladie historique a ne pas oublier ; cela evitera des investigations inutiles ou agressives.

Resume Contexte Le nombre de consultations dans les services d’accueil des urgences (SAU) pediatriques n’a cesse d’augmenter depuis 20 ans en France et dans le monde, particulierement pour les nouveau-nes (moins de 28 jours). Objectifs Determiner les motifs de consultations des nouveau-nes au SAU et identifier le nombre de consultations qui auraient pu etre gerees en ambulatoire. Methode Etude epidemiologique, retrospective des dossiers informatiques des nouveau-nes ayant consulte au SAU pediatrique du CHU de Saint-Etienne du 1er janvier au 31 decembre 2011. Les 4 criteres combines (1) enfant non adresse par un professionnel de sante, (2) score de gravite G1, G2, ou G3 de notre echelle interne a l’accueil, (3) absence de realisation d’examen complementaire et (4) retour a domicile ont ete retenus pour definir les consultations non urgentes. Resultats Quatre cent dix-neuf nouveau-nes ont ete inclus dans l’etude. Les premiers motifs de consultations avaient ete les pleurs (14,1 %), les vomissements (11,9 %), la gene respiratoire (10,7 %), la fievre (8,1 %) et la diarrhee (7 %). Les premiers diagnostics retenus avaient ete la rhino-pharyngite aigue (11,5 %), le reflux gastro-œsophagien (10 %), les coliques (8,1 %) et l’inquietude parentale exageree (7,6 %) et 52,4 % des consultations ont ete considerees comme non urgentes. Conclusions Les diagnostics retenus sont concordants avec les motifs de consultations. Les pleurs inexpliques et l’inexperience des jeunes parents se traduisent par une inquietude irraisonnee. Cette etude met en exergue la necessite d’un accompagnement parental a domicile des la sortie de maternite et le recours a des initiatives educatives d’envergure.

Highlights • Systematic antimicrobials are recommended in community-acquired pneumonia of child. • A large panel of bacteria and viruses was detected in 85 children exhibiting CAP. • More than 60% of children with CAP exhibited an exclusive viral infection. • A co-infection with at least 2 viruses was observed in >40% of the children. • Data suggest that the use of antimicrobials in child's CAP should be revisited., Background The management of children with community-acquired pneumonia (CAP) is largely influenced by the development of new molecular diagnostic tests that allow the simultaneous detection of a wide range of pathogens. Objectives Evaluation of a diagnostic approach including multiplex PCR assays for revisiting the epidemiology and etiology of CAP in children at hospital. Study design Children of all ages consulting at the Emergency Department of the University hospital of Saint-Etienne, France, during the 2012–2013 winter period were included. In addition to bacterial cultures, the following pathogens were detected using biplex commercially-available rt-PCR tests: adenovirus, respiratory syncytial virus, human metapneumovirus, bocavirus, rhinovirus/enterovirus, coronavirus, influenza viruses A and B, parainfluenza viruses, Mycoplasma pneumoniae and Chlamydophila pneumonia. Results From 85 patients with CAP, at least one pathogen was identified in 81 cases (95.3%), including 4 bacterial exclusive infections (4.7%), 53 viral exclusive infections (62.4%) and 24 mixed infections (28.2%). Coinfection by at least two viruses was observed in 37 cases (43.5%). Mean age was higher in the case of documented bacterial infection (P

Resume Contexte Le rotavirus est le principal agent infectieux des gastroenterites aigues severes (GEA) chez le nourrisson et l’enfant de moins de cinq ans. Compte tenu de la disponibilite recente de nouveaux vaccins, il est important d’evaluer precisement le taux d’incidence des gastroenterites a rotavirus (GERV) communautaires et leurs consequences medico-epidemiologiques. Methodes Ce travail est le versant francais du programme d’etudes SPRIK. Il s’agit d’etude multicentrique, prospective, observationnelle realisee entre octobre 2005 et mai 2007, destinee a estimer chez les enfants de moins de cinq ans l’incidence annuelle des GERV qui ont conduit a une consultation chez un medecin generaliste ou un pediatre. Il presente les donnees collectees par 41 medecins generalistes et 36 pediatres repartis sur l’ensemble du territoire francais metropolitain. Un echantillon de selles a ete preleve pour chaque enfant. La presence de rotavirus a ete recherchee par le medecin a l’aide d’un test immunochromatographique rapide. Resultats Un total de 1648 episodes de GEA correspondant a 1463 patients eligibles a ete inclus dans l’etude, essentiellement de decembre a mai (pic en fevrier–mars). Le taux d’incidence des GERV donnant lieu a une consultation en medecine de ville a ete de 1357 cas pour 100 000 sujets-annees (1,36 %), avec un intervalle de confiance a 95 % de [1345–1368]. Le pic d’incidence a ete observe avant l’âge de deux ans. Les GERV ont represente 21 % de l’ensemble des GEA. Les patients ayant une GERV etaient plus jeunes (14,1 ± 10,8 mois versus 18,4 ± 13,9 mois pour les autres GEA, p p p p Conclusion Le taux d’incidence rapporte dans cette etude est proche de ceux de precedents travaux realises en Europe. La frequence et la gravite relative des GERV communautaires plaident en faveur d’une vaccination chez les tres jeunes enfants pour reduire le fardeau lie a cette pathologie.

International audience; Group A rotavirus (RVA) is the leading cause of acute gastroenteritis in young children worldwide. A prospective surveillance network has been set up to investigate the virological and clinical features of RVA infections and to detect the emergence of potentially epidemic strains in France. From 2009 to 2014, RVA-positive stool samples were collected from 4800 children

Resume Contexte En France, les infections a Rotavirus sont responsables chaque annee d’environ 300 000 episodes de gastroenterite aigue (GEA) chez les enfants de moins de cinq ans. Elles sont egalement a l’origine de 138 000 consultations en ville et de 18 000 hospitalisations. L’etude Surveillance for Hospitalized Rotavirus Infections in Kids (SHRIK) est une etude prospective observationnelle europeenne realisee afin d’evaluer le fardeau des gastroenterites a Rotavirus (GERV) chez ces enfants. Methode L’etude SHRIK se deroulait sur une periode d’un an et s’adressait aux patients de moins de cinq ans ayant consulte le service des urgences pour une gastroenterite aigue (GE-U), ayant ete hospitalises pour une gastroenterite aigue (GE-H) ou ayant developpe une GERV 48 heures apres leur hospitalisation (GE-N). Un echantillon de selles etait preleve pour chacun des enfants inclus et analyse par methode Elisa. Resultats Les resultats presentes concernent les patients inclus en France. Un total de 755 patients atteints de GEA et âges de moins de cinq ans a ete inclus (357 pour une GE-U, 372 pour une GE-H et 26 pour une GE-N). Parmi ces patients, la proportion de GERV etait de 49,1 % pour les GE-U (n = 114) et de 64,4 % pour les GE-H (n = 186). La majorite (89 %) des GERV concernait des enfants de moins de deux ans. Selon l’echelle de Vesikari, la GEA des patients GERV etait plus frequemment qualifiee de « severe » que celle des patients atteints de gastroenterite non a Rotavirus (GENRV) (68,4 % contre 41,9 %, p Conclusion L’etude SHRIK montre que le fardeau des infections a Rotavirus est eleve ; elles representent plus de 70 % des GEA traitees a l’hopital au cours du pic hivernal.

Resume Nous rapportons une intoxication accidentelle par cannabis chez une petite fille de 10 mois. Celle-ci presentait depuis quelques heures des troubles de la conscience associant en alternance somnolence et agitation, une hypotonie generalisee, une fixite du regard et des sourires inadaptes. Il n’existait pas de troubles cardiorespiratoires. Les investigations complementaires initiales etaient normales (biologie sanguine, examen du liquide cephalo-rachidien et scanner cerebral), eliminant de premier abord les principales causes de coma (meningo-encephalite, traumatisme crânien, desordres metaboliques). Un interrogatoire oriente des parents conduisait a suspecter une absorption accidentelle d’un morceau de cannabis, confirmee par la mise en evidence de taux sanguins et urinaires eleves de derives cannabinoides. La prise en charge etait symptomatique et l’evolution clinique marquee par la survenue d’une phase d’agitation et d’irritabilite persistant 18 h puis par une regression complete de la symptomatologie. Du fait de l’importance de sa consommation en France, l’intoxication pediatrique par le cannabis semble de plus en plus frequente. Les seuils toxiques chez l’enfant ne sont cependant pas connus. Le diagnostic repose sur l’interrogatoire et sur la recherche de derives cannabinoides dans les urines. La symptomatologie clinique, plus prolixe chez l’enfant que chez l’adulte, reunit des manifestations neurologiques (somnolence, agitation, troubles du comportement, ataxie, hypotonie, coma, convulsions), cardiorespiratoires (tachycardie, bradypnee, apnee) ou homeostasiques (hypothermie). Le traitement est essentiellement symptomatique mais necessite parfois une reanimation active. Les recommandations preconisent une surveillance clinique de 6 a 24 h apres l’intoxication et une prise en charge medico-sociale adaptee.

The optimal age for measles vaccination is an important health issue, since maternal antibodies may neutralize the vaccine antigen before a specific immune response develops, while delaying vaccination may increase the risk of complicated diseases in infants. However, measles vaccination impacts the duration of protection afforded by transplacental transfer of maternal antibodies: vaccination-induced maternal antibodies disappear faster than disease-induced antibodies. In order to maintain protection against measles in infants, it is important to monitor the dynamics of this phenomenon in vaccinated populations. To assess the current situation in France, a multicenter, prospective seroepidemiological study was conducted in seven French hospitals between October 2005 and January 2007. Maternal measles antibody concentrations from 348 infants 0 to 15 months old were measured using the plaque reduction neutralization assay. Geometric mean concentrations and the percentage of infants with maternal measles antibody concentrations above the protection threshold (≥120 mIU/ml) were assessed according to age. Results show that after more than 20 years of routine measles vaccination in France, maternal measles-neutralizing antibodies decrease dramatically in French infants by 6 months of age, from 1,740 mIU/ml for infants 0 to 1 month old to 223 mIU/ml for infants 5 to 6 months old, and that 90% of infants are not protected against measles after 6 months of age. Infant protection against measles could be optimized both by increasing herd immunity through an increased vaccine coverage and by lowering the age of routine vaccination from 12 to 9 months.

Resume La couverture vaccinale (CV) contre la rougeole a augmente de facon significative en France des 1983 (annee de la recommandation officielle). La majorite des femmes nees apres 1983 serait donc davantage immunisee par la vaccination plutot que par la maladie. Les anticorps antirougeole (AcR) maternels transmis pendant la grossesse protegent les nourrissons pendant les premiers mois de vie. Objectif Comparer les titres d’AcR neutralisants en fonction de l’âge chez les femmes de 12 a 40 ans, nees avant et apres 1983. Methodes Etude seroepidemiologique multicentrique realisee en France (octobre 2005–mai 2006). Au total, 210 femmes hospitalisees ou consultant a l’hopital ont ete inclues et reparties en 4 groupes d’âge (12–18 ; 19–22 ; 23–30 et 31–40 ans). Mesure des titres d’AcR par le test de reference de neutralisation par reduction de plages (seuil de protection > 120 mUI/ml). Resultats La moyenne geometrique des titres (MGT) d’AcR etait significativement superieure chez les femmes nees avant 1983 versus apres 1983 (MGT : 1358 versus 731 mUI/ml [ p p re fois en France, nous montrons que chez les femmes en âge de procreer les titres moyens des AcR neutralisants sont en 2005–2006 largement au-dessus du seuil de protection, quel que soit l’âge et que les femmes les plus jeunes (CV elevee) ont des titres significativement plus bas. La duree de protection conferee par les AcR transmis a leurs nourrissons pourrait ainsi etre reduite.

International audience; When epidemics occur, such as is the case for Bronchiolitis in pediatric ED, the patient flow in the ED incontestably increases and can lead to crowding. We bypassed this difficulty of forecasting patient flow with aggregated weekly or monthly data, by tackling the problem from a different point of view. We used daily data to build a multi-period Serfling-based model. This model is hereinafter assimilated to normal ED flow. We then used the fourth-order moment of distribution of the Time Series, obtained from the difference between the estimated model and the real data, to provide an early index announcing abnormal ED patient flow. This index is parameter-dependent and we provide a criterion to assist in selecting the optimal parameters. A simple program based on this methodology has been developed and has been given to the pediatric physicians for testing. Thanks to this index, the Pediatric ED was able to anticipate crowding almost three weeks before the height of the Bronchiolitis epidemic.

Trichobezoars are made up of concretions of ingested hair and food. A history of occlusive syndrome in a context of trichotillomania and psychological problems must lead to this diagnosis. Bezoars can be fortuitously recognised by palpation of an epigastric abdominal mass while investigating anemia or esophageal reflux. This deviance is particularly dangerous. The first case of this series illustrates the Rapunzel syndrome with many perforations and necrosis of the small bowel. The 4 others are strict intragastric bezoars, quickly identified by echography. Treatment is exclusively surgical, digestion by papain or endoscopic extraction being impossible. Psychological assistance is mandatory.

This study describes the development and evaluation of a new commercial test, Chlamylege (Argene Inc.), which allows the simultaneous detection in respiratory samples of Chlamydophila pneumoniae , Mycoplasma pneumoniae , and most Legionella species, as well as PCR inhibitors, by using a multiplex PCR and microplate hybridization. The sensitivities of Chlamylege were 1 × 10 −3 IFU, 5 × 10 −2 color-changing units, and 1 CFU per reaction tube for C. pneumoniae , M. pneumoniae , and Legionella pneumophila , respectively. A cohort of 154 clinical samples from patients with documented respiratory infections was analyzed by the kit, including 2 samples from patients with C. pneumoniae infection, 9 samples from patients with M. pneumoniae infection, 19 samples from patients with Legionella species infection, and 114 samples that tested negative for the three pathogens. All the positive specimens were correctly detected and identified by the Chlamylege kit, and no false-positive result was observed with the negative samples. The kit was then evaluated in a pediatric prospective study that included 220 endotracheal aspirates, and the results were compared with those obtained by three single in-house PCR assays. Four specimens were found to be positive for C. pneumoniae and six were found to be positive for M. pneumoniae by using both strategies. The Chlamylege kit detected two additional samples positive for M. pneumoniae and one additional sample positive for a Legionella species other than L. pneumophila ; these three samples were shown to be true positive by other techniques. These overall results demonstrate that the Chlamylege assay is sensitive, specific, and convenient for the rapid detection and identification of atypical pathogens in clinical samples from patients with respiratory infections.

The number of visits to the pediatric emergency services has increased in the past 20 years in France and around the world, especially for neonates (under 28 days of age).Determine for neonates the reasons requiring medical consultation in the emergency pediatric unit of Saint-Etienne University Hospital (France) and isolate the proportion of "non-urgent" preventable consultations that could be managed outside of emergency units.Epidemiological, retrospective study on computerized data on neonates who were referred to the pediatric emergency unit of the Saint-Étienne University Hospital from 1 January to 31 December 2011. Four composite criteria "child not addressed by a healthcare professional; severity score G1, G2, G3 based on an internal scale; no further review undertaken; and return home" were used to define "non-urgent" consultations.A total of 419 infants were included in the study. The leading reasons for consultations were crying (14.1%), vomiting (11.9%), chest tightness (10.7%), fever (8.1%), and diarrhea (7%). The main diagnoses were acute nasopharyngitis (11.5%), gastroesophageal reflux (10%), colic (8.1%), and excessive parental anxiety (7.6%). The percentage of "non-urgent" consultations was 52.4%.Final diagnoses are quite similar to the reasons for consultation. The baby's unexplained crying and the inexperience of young parents resulted in an irrational anxiety. This study highlights the need for parental support at home after discharge from the maternity ward and the use of large-scale educational initiatives.

Corrigendum to “Contamination of healthcare workers' mobile phones by epidemic viruses” [Clin Microbiol Infect (2016) 456.e1e456.e6] S. Pillet 1, , P. Berthelot 1, 2, , A. Gagneux-Brunon 1, , O. Mory , C. Gay , A. Viallon , F. Lucht 1, , B. Pozzetto 1, , E. Botelho-Nevers 1, 3, * 1) GIMAP EA 3064 (Groupe Immunit e des Muqueuses et Agents Pathog enes), University of Lyon, Saint-Etienne, France 2) Laboratory of Infectious Agents and Hygiene, University Hospital of SaintEtienne, SaintEtienne, France 3) Infectious Diseases Department, University Hospital of SaintEtienne, SaintEtienne, France 4) Paediatric Emergency Department, University Hospital of SaintEtienne, SaintEtienne, France 5) Paediatric Department, University Hospital of SaintEtienne, SaintEtienne, France 6) Adult Emergency Department, University Hospital of SaintEtienne, SaintEtienne, France

Mobile phones (MPs) are potential reservoirs of nosocomial bacteria, but few data are available concerning viruses. We aimed to evaluate the presence of virus RNA from epidemic viruses including metapneumovirus, respiratory syncytial virus, influenza viruses, rotavirus (RV) and norovirus on the MPs used by healthcare workers (HCWs) and to relate it to hygiene measures. An anonymous behavioural questionnaire about MP use at hospital was administered to the HCWs of four adult and paediatric departments of a university hospital. After sampling personal (PMP) and/or professional MPs (digital enhanced cordless telephone, DECT), virus RNAs were extracted and amplified by one-step real-time reverse transcription-quantitative PCR. The molecular results were analysed in a masked manner in relation to the behavioural survey. Questionnaires from 114 HCWs (25 [corrected] senior physicians, 30 residents, 32 nurses, 27 nurses' assistants) working either in adult (n = 58) or paediatric (n = 56) departments were analysed. Medical personnel used their PMP more frequently than paramedical HCWs (33/65 vs. 10/59, p 0.001). MPs were used during care more frequently in adult wards than in paediatric ones (46/58 vs. 27/56, p 0.001). Virus RNA was detected on 42/109 (38.5%) collected MPs, with RV found on 39, respiratory syncytial virus on three and metapneumovirus on one. The presence of virus RNA was significantly associated with MPs from the paediatric HCWs (p 0.001). MPs routinely used in hospital, even during care, can host virus RNA, especially RV. Promotion of frequent hand hygiene before and after MP use, along with frequent cleaning of MPs, should be encouraged.

We describe a case of accidental cannabis poisoning in a 10-month-old girl, who presented with impaired consciousness, with drowsiness and restlessness, generalized hypotonia, and inadequate smiles. No circulatory or respiratory problems were observed. Initial investigations were not informative (blood biology, CT scan, and cerebrospinal fluid examination), while the main causes of coma (meningoencephalitis, head trauma, metabolic disorders) were excluded. Questioning the parents led to suspecting accidental ingestion of a piece of cannabis, which was confirmed by the detection of high blood and urine levels of cannabinoid derivatives. Management was symptomatic and the clinical course, marked by the occurrence of agitation and irritability episodes lasting up to H18, led to complete regression of symptoms. Because of the high consumption in France, pediatric poisoning by cannabis seems increasingly common. The toxic levels in children are unknown however. Diagnosis is based on questioning and the search for cannabinoid derivatives in urine. In children, clinical symptoms are more expressive compared to adults, with neurological (drowsiness, agitation, abnormal behavior, ataxia, hypotonia, coma, and convulsions) or cardiopulmonary (tachycardia, bradypnea, apnea) or homeostatic presentations (hypothermia). Treatment in children is essentially symptomatic but sometimes requires active resuscitation. Recommendations are based on clinical monitoring the first 24h after intoxication and on medicosocial support.

Varicella is a widespread disease of childhood resulting from primary infection with varicella-zoster virus (VZV). The objective of this study was to determine the kinetics of the decline of maternal anti-VZV antibodies in French infants between birth and the age of 15 months in order to estimate the duration of passively acquired maternal anti-VZV immunoglobulin G (IgG). This prospective multicenter study was conducted between October 2005 and January 2007 in the pediatric wards and/or pediatric emergency units of seven French hospitals scattered throughout the country. The level of anti-VZV IgG antibodies in serum was measured by a time-resolved fluorescence immunoassay (TRFIA) (the threshold considered positive is 150 mIU/ml). A total of 345 infants were included. Seventy-seven percent of mothers reported a history of varicella. A rapid decline in the prevalence of anti-VZV antibodies was observed during the first few months of life, with the mean antibody titer decreasing from 536 mIU/ml at birth and through 1 month to below the 150-mIU/ml threshold at 3 to 4 months. The half-life of passively acquired maternal immunoglobulins was around 6 weeks. Based on a large number of subjects, this study clearly demonstrated, for the first time in France, high levels of passively acquired maternal antibodies during the neonatal period, and it allowed us to estimate the duration of passively acquired maternal anti-VZV IgG in French infants. After 4 to 5 months, infants had very low levels of maternal anti-VZV IgG, below the 150-mIU/ml cutoff of the VZV IgG TRFIA.

Measles-vaccine coverage (MVC) increased significantly only beginning in 1983 based on the official recommendations. The majority of women born after 1983 should have vaccine-acquired rather than naturally derived immunity. Passively transferred measles antibodies (Mab) are expected to provide protection to offsprings during their 1st few months of life.Compare neutralizing Mab titers according to age in women aged 12-40 years, i.e., born before and after 1983.A multicenter seroepidemiological study was conducted in France in 2005-2006; 210 outpatient or hospitalized women were enrolled and classified into 4 age groups (12-18, 19-22, 23-30, and 31-40 years). Mab titers were assessed using a reference plaque reduction neutralization assay (protection threshold120 mIU/ml).Ninety-four percent of subjects had a Mabs titer greater than 120 mIU/ml. Women born before 1983 had significantly higher geometric mean titers (GMTs) of Mabs than those born after 1983(1358 mIU/ml vs. 731 mIU/ml [p0.001]). The comparison of the 4 cohorts showed a significant decrease (p0.001) in GMTs of Mab in the female population with increasing age (670, 771, 1173, and 1821 mUI/ml, respectively, in the 12-18, 19-22, 23-30, and 31-40 years age groups). For the 1st time in France, we show in women of childbearing age that in 2005-2006 neutralizing Mab GMTs were far above protective threshold for all age groups. Women in younger age groups (with high MVC) have significantly lower Mab titers. A lower passive transfer of Mab to their offsprings could result in a shorter period of measles protection and question the measles vaccine 1st dose at 1 year.

This study describes the development and evaluation of a new commercial test, Chlamylege (Argene Inc.), which allows the simultaneous detection in respiratory samples of Chlamydophila pneumoniae, Mycoplasma pneumoniae, and most Legionella species, as well as PCR inhibitors, by using a multiplex PCR and microplate hybridization. The sensitivities of Chlamylege were 1 x 10(-3) IFU, 5 x 10(-2) color-changing units, and 1 CFU per reaction tube for C. pneumoniae, M. pneumoniae, and Legionella pneumophila, respectively. A cohort of 154 clinical samples from patients with documented respiratory infections was analyzed by the kit, including 2 samples from patients with C. pneumoniae infection, 9 samples from patients with M. pneumoniae infection, 19 samples from patients with Legionella species infection, and 114 samples that tested negative for the three pathogens. All the positive specimens were correctly detected and identified by the Chlamylege kit, and no false-positive result was observed with the negative samples. The kit was then evaluated in a pediatric prospective study that included 220 endotracheal aspirates, and the results were compared with those obtained by three single in-house PCR assays. Four specimens were found to be positive for C. pneumoniae and six were found to be positive for M. pneumoniae by using both strategies. The Chlamylege kit detected two additional samples positive for M. pneumoniae and one additional sample positive for a Legionella species other than L. pneumophila; these three samples were shown to be true positive by other techniques. These overall results demonstrate that the Chlamylege assay is sensitive, specific, and convenient for the rapid detection and identification of atypical pathogens in clinical samples from patients with respiratory infections.

Trichobezoars are made up of concretions of ingested hair and food. A history of occlusive syndrome in a context of trichotillomania and psychological problems must lead to this diagnosis. Bezoars can be fortuitously recognised by palpation of an epigastric abdominal mass while investigating anemia or esophageal reflux. This deviance is particularly dangerous. The first case of this series illustrates the Rapunzel syndrome with many perforations and necrosis of the small bowel. The 4 others are strict intragastric bezoars, quickly identified by echography. Treatment is exclusively surgical, digestion by papain or endoscopic extraction being impossible. Psychological assistance is mandatory.