BCG et médecin généraliste (comment appréhender une éventuelle modification de la politique vaccinale antituberculeuse en France?)

PARIS6-Bibl. St Antoine CHU (751122104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Eléments d'orientation dans le dépistage de la tuberculose infantile à partir d'une enquête rétrospective menée de 1997 à 2004 dans le service de pédiatrie de l'hôpital de Gonesse (Val d'Oise)

La tuberculose reste une maladie d actualité en France notamment en Ile-de-France. Avec un taux d incidence de tuberculose de 22,1 pour 100 000 habitants en 2004, le Val d Oise est le troisième département le plus touché de la région parisienne après Paris et la Seine-Saint-Denis. Au vu de l arrêt récent de l obligation vaccinale par le BCG et la récente suppression des contrôles vaccinaux systématiques, il est important de cerner la population à risque nécessitant un dépistage plus intense. La tuberculose infantile a pour particularité de refléter le taux de transmission de la maladie dans une population. Nous analyserons les données épidémiologiques et socio-économiques obtenues à partir de l étude rétrospective des cas de tuberculose chez l enfant pris en charge dans le service de pédiatrie à l hôpital de Gonesse, Val d Oise, de 1997 à 2004. Notre étude comprend 168 dossiers soit 108 cas de tuberculose infection et 60 cas de tuberculose maladie. Le but de notre travail est d identifier les facteurs de risque en particulier socio-économiques, et d aider à mieux définir les populations à risque afin d orienter les mesures de lutte anti-tuberculose et limiter la transmission du Bacille de Koch.Tuberculosis remains a disease of concern in France, in particular in Ile-de-France. With an incidence rate of 22,1 per 100.000 inhabitants in 2004, Val d Oise is the third more affected department in Paris area, after Paris and Seine-Saint-Denis. Consequently to the fact that vaccination with BCG is no more mandatory and the recent suppression of systematic vaccine controls, it is important to identify the population at risk which requires a more intense screening. Infantile tuberculosis has as a characteristic to reflect the transmission rate of the disease in a given population. We will analyze the epidemiologic and socio-economic data obtained from the retrospective study of child tuberculosis cases treated by the pediatric department of Gonesse s hospital, Val d Oise, date range from 1997 to 2004. Our study includes 168 files, concerning 108 cases of tuberculosis infection and 60 cases of tuberculosis disease. Our goal is to identify socio-economic risk factors to help in better defining the populations at risk in order to direct anti-tuberculosis measures and limit Koch s Bacillus transmission.PARIS13-BU Serge Lebovici (930082101) / SudocSudocFranceF

BCG et médecin généraliste (comment appréhender une éventuelle modification de la politique vaccinale antituberculeuse en France?)

PARIS6-Bibl. St Antoine CHU (751122104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Central retinal vein occlusion in a sickle cell trait carrier after a cycling race.: SCT and ophthalmologic complications

International audienceA 26-yr-old man with sickle cell trait (SCT) suddenly lost visual acuity in the left eye after a cycling race in hot tropical environment. The cause was massive central retinal vein occlusion (CRVO) with hemorrhaging that rapidly worsened to neovascular glaucoma. Although medically treated, the eye is now marked by total retinal detachment. Cardiovascular function assessment shows no electrocardiographic abnormalities, no anomaly in the supra-aortic tree, and no evidence of structural heart disease. Although normal coagulation markers values (i.e., activated partial thromboplastin time, prothrombin time, fibrinogen concentration, antithrombin III, factor V, proteins C and S) were observed 2.5 months after the clinical event, a transesophageal echocardiogram performed few hours after the incident revealed the presence of four thrombi in the left atrium suggesting a postexercise hypercoagulable state at that time. Hemorheological measurements at distance of the events demonstrated high red blood cell rigidity at baseline. Therefore, marked blood rheological impairment and activation of the coagulation pathway in response to the heavy and prolonged cycling race could have promoted CRVO in this cyclist carrying SCT. These data suggest that SCT could be considered as a risk factor for significant ocular complications when severe exercise is performed and support the idea that SCT is a contributing factor in blood rheology and vascular dysfunctions