Tick-borne encephalitis presenting as fever without localising signs—a case series

Introduction: Tick-borne encephalitis (TBE) presents without neurologic symptoms in 19% in children less than 16years in Switzerland (2000-2008). In these cases, fever can be the only leading manifestation. Case series: We report on four hospitalised children who had TBE and presented as fever without localising signs (FWLS) between 2000 and 2008 in an endemic area in Switzerland. Conclusion: TBE infection has to be considered in the differential diagnosis of FWLS in endemic areas. Foremost, FWLS characterised by a biphasic fever course and accompanied by headache in patients in a reduced general condition. Affirming that in patients presenting as FWLS also cases of TBE are contained, this disease is underreporte

Gout in pediatric renal transplant recipients

Clinical gout has rarely been described after pediatric renal transplantation (RTx), although asymptomatic hyperuricemia is common in these patients. We describe three male pediatric patients who presented with gouty arthritis 7-8.5 years following RTx. Since receiving allopurinol, all patients had been free of gouty symptoms. To prevent severe bone marrow depletion, the dosage of azathioprine, an immunosupressant drug, was reduced by 50% to prevent interaction with allopurinol. Because atypical presentation of gout can occur, a high index of suspicion is needed to allow appropriate diagnosis of this disease in patients with skeletal pain after RT

Randomised trial of oral versus sequential intravenous/oral cephalosporins in children with pyelonephritis

The hypothesis was tested that oral antibiotic treatment in children with acute pyelonephritis and scintigraphy-documented lesions is equally as efficacious as sequential intravenous/oral therapy with respect to the incidence of renal scarring. A randomised multi-centre trial was conducted in 365 children aged 6 months to 16years with bacterial growth in cultures from urine collected by catheter. The children were assigned to receive either oral ceftibuten (9mg/kg once daily) for 14days or intravenous ceftriaxone (50mg/kg once daily) for 3days followed by oral ceftibuten for 11days. Only patients with lesions detected on acute-phase dimercaptosuccinic acid (DMSA) scintigraphy underwent follow-up scintigraphy. Efficacy was evaluated by the rate of renal scarring after 6 months on follow-up scintigraphy. Of 219 children with lesions on acute-phase scintigraphy, 152 completed the study; 80 (72 females, median age 2.2 years) were given ceftibuten and 72 (62 females, median age 1.6years) were given ceftriaxone/ceftibuten. Patients in the intravenous/oral group had significantly higher C-reactive protein (CRP) concentrations at baseline and larger lesion(s) on acute-phase scintigraphy. Follow-up scintigraphy showed renal scarring in 21/80 children treated with ceftibuten and 33/72 with ceftriaxone/ceftibuten (p = 0.01). However, after adjustment for the confounding variables (CRP and size of acute-phase lesion), no significant difference was observed for renal scarring between the two groups (p = 0.2). Renal scarring correlated with the extent of the acute-phase lesion (r = 0.60, p < 0.0001) and the grade of vesico-ureteric reflux (r = 0.31, p = 0.03), and was more frequent in refluxing renal units (p = 0.04). The majority of patients, i.e. 44 in the oral group and 47 in the intravenous/oral group, were managed as out-patients. Side effects were not observed. From this study, we can conclude that once-daily oral ceftibuten for 14days yielded comparable results to sequential ceftriaxone/ceftibuten treatment in children aged 6months to 16years with DMSA-documented acute pyelonephritis and it allowed out-patient management in the majority of these childre

Nietzsche et la théâtralité (esquisse d'une généalogie de l'acteur)

Ce travail se propose, à la croisée de champs interdisciplinaires et d'une lecture intertextuelle, de dégager une théâtralité qu'une généalogie de l'acteur révélera à travers une variété de figures. Sa définition hors du théâtre en fera ressortir une caractéristique essentielle : une altérité radicale. Sa présence multiforme sera interrogée à différents niveaux. Du théâtre pour commencer où elle paraît évidente, la théâtralité ne se présenterait-elle pas plus fondamentalement comme un instinct ou un jeu, révélateurs d'une vérité originaire ? La difficile articulation de la création et de l'imitation rendra compte de la délicate question de l'originalité : comment devient-on inimitable ? Question pour l'écrivain, elle se posera également pour l'acteur. Si l'écart entre le théâtral et le vécu est respecté dans le jeu des acteurs du chœur de la tragédie grecque, y compris à sa naissance, en revanche, cet écart sera violemment critiqué par une tradition que Platon inaugure et que perpétueront les Pères de l'Eglise et Rousseau même s'ils sont portés par d'autres motifs et schémas de pensée. Il reste, qu'au fond, ce qui les rend irascibles devant cette puissance inquiétante, ce n'est rien d'autre que le côté féminin de l'acteur. C'est ce danger que Nietzsche aura perçu et pensé comme une hystérisation et un histrionisme : un phénomène envahissant dans tous les domaines jusqu'à les parasiter : de la musique wagnérienne à l'histoire, des mythes à la culture et à la presse où les Juifs vont se distinguer. Défiance et admiration pour ce peuple de comédiens de l'errance, et du Salut quand ils se font prêtres chrétiens, Nietzsche retrouvera cette ambivalence à l'égard de l'énigmatique comédienne qu'est la femme. De cette inimitable théâtralité et de cette inaltérable altérité que représentent les Juifs et les femmes, Nietzsche n'aura pu s'approcher qu'en assistant, derrière ses propres masques, à sa propre tragédie. Pour guérir de soi-même en devenant autre, il lui aura fallu , non seulement prendre les masques des autres, mais se jouer à lui-même son unique personnage sur sa propre scène où il a rejoint Dionysos.STRASBOURG-B.N.U.S. (674821001) / SudocSudocFranceF

Tick-borne encephalitis presenting as fever without localising signs—a case series

Introduction: Tick-borne encephalitis (TBE) presents without neurologic symptoms in 19% in children less than 16years in Switzerland (2000-2008). In these cases, fever can be the only leading manifestation. Case series: We report on four hospitalised children who had TBE and presented as fever without localising signs (FWLS) between 2000 and 2008 in an endemic area in Switzerland. Conclusion: TBE infection has to be considered in the differential diagnosis of FWLS in endemic areas. Foremost, FWLS characterised by a biphasic fever course and accompanied by headache in patients in a reduced general condition. Affirming that in patients presenting as FWLS also cases of TBE are contained, this disease is underreporte

Mycoplasma pneumoniae and mucositis - part of the Stevens-Johnson syndrome spectrum

BACKGROUND Mycoplasma pneumoniae may induce mucosal inflammation, referred to as M. pneumoniae-associated mucositis (MPAM). There is no generally accepted definition of MPAM, since there may be mucosal lesions only, or mucosal and minimal skin lesions. PATIENTS AND METHODS We conducted a literature review of MPAM, paying particular attention to pathogenesis, clinical manifestations, treatment decisions, and prognosis. RESULTS We identified 32 cases of MPAM (median age 13.5 years), whereof 23 patients were otherwise healthy children and young adolescents (72%). M. pneumoniae infection was associated with fever and respiratory symptoms in all calls; it was confirmed by serology (n = 30) and/or PCR (n = 9). Oral lesions were present in all cases, followed by ocular (97%) and uro-genital lesions (78%). Despite the syndrome's name postulating the absence of cutaneous involvement, minimal skin lesions occurred in 31%. Treatment regimens included systemic antibiotics (100%) and systemic anti-inflammatory treatment with corticosteroids (31%) or immunoglobulins (9%). Macrolides were given in 81%, with failure, relapse, and/or worsening in one-third of patients. No patient suffered long-term sequelae. CONCLUSION MPAM is a distinct extra-pulmonary manifestation falling into the continuum of Stevens-Johnson syndrome. This entity may be due to inflammatory mechanisms suggesting that systemic anti-inflammatory treatment is even more important than antimicrobials

Neuroinvasive Mycoplasma pneumoniae infection without intrathecal antibody response

The pathogenesis of extrapulmonary Mycoplasma pneumoniae-associated neurologic disease is unclear. We present a case of acute meningoencephalitis in a 15-year-old girl with central nervous system invasion of the bacterium but without intrathecal antibody synthesis. Our observations suggest that in this setting M. pneumoniae infection can be self-limiting and mild despite invasion of the central nervous system

KOMPASS - Zürcher Kompetenztraining für Jugendliche mit Autismus-Spektrum-Störungen

Das im therapeutischen Alltag entwickelte Trainingsprogramm vermittelt soziale Kompetenzen für Menschen mit Autismus-Spektrum-Störungen. Es ist personzentriert, ressourcenorientiert und zielt auf die Arbeit im Gruppen- oder Einzelsetting mit Jugendlichen, ist aber auch bei älteren Kindern und jungen Erwachsenen anwendbar. Evaluationsergebnisse zeigen einen im Alltag beobachtbaren Abbau der autistischen Symptomatik und einen Zuwachs an sozialen Kompetenzen durch das Training. Konzept und Vorgehensweise im KOMPASS-Training sowie die Module Emotionen, Small Talk und Nonverbale Kommunikation werden anwendungsorientiert beschrieben. Über Content+ können zahlreiche Arbeitsmaterialien heruntergeladen werden

KOMPASS-F - Zürcher Kompetenztraining für Fortgeschrittene für Jugendliche und junge Erwachsene mit einer Autismus-Spektrum-Störung : Ein Praxishandbuch

Das im therapeutischen Alltag entwickelte und gut evaluierte Trainingsprogramm KOMPASS-F stellt die Fortsetzung des KOMPASS-Basistrainings (Jenny et al. 2011) dar. Die neuen Module "Komplexe Kommunikation", "Komplexe Interaktion" und "Theory of Mind" behandeln zahlreiche Themen und Kompetenzen. Trainingskonzept, Vorgehensweise und alle Übungen werden anwendungsorientiert beschrieben. Informationsblätter mit dem notwendigen Hintergrundwissen für die Fachperson wie auch die Jugendlichen und jungen Erwachsenen mit ASS sowie ausführliche Arbeitsmaterialien stehen zum Download bereit