Paludisme grave d'importation chez l'enfant en France (étude nationale rétrospective de 1996 à 2005)

Les travaux consacrés au paludisme grave pédiatrique d importation sont rares et peu informatifs. Nous avons voulu, dans une étude nationale rétrospective, en préciser les facteurs de survenue, rechercher les facteurs prédictifs de gravité et évaluer la pertinence des critères de gravité de l OMS chez l enfant voyageur. A partir de la base de données du Centre National de Référence du paludisme concernant les enfants âgés de 0 à 15 ans hospitalisés pour un paludisme à Plasmodium falciparum, de 1996 à 2005, nous avons d abord recherché des facteurs associés à la survenue d une forme grave. Puis nous avons étudié les dossiers de paludisme grave, défini selon les critères OMS 2000, dans les 12 hôpitaux ayant déclaré plus de 5 cas pendant la période étudiée. Pour ce travail, la pertinence des critères OMS 2000 et les facteurs prédictifs de gravité ont été évalués, en l absence de décès, par le recours aux actes thérapeutiques majeurs (ATM) ou à un séjour en réanimation, en analyse univariée et multivariée ; le seuil de parasitémie associé à la gravité dans cette série a été recherché par la réalisation de courbes ROC. Parmi 4 150 enfants inclus, 3 299 avaient une forme simple et 851 avaient une forme grave. Les facteurs indépendants prédictifs de la survenue d une forme grave étaient le jeune âge (OR allant de 1,4 chez les 5-9 ans, à 3,2 chez les moins de 2 ans, p= 4 %, n avait pas de valeur pronostique chez l enfant voyageur. Mais l hyperparasitémie isolée définie au seuil de 8 % était plus sensible pour repérer les enfants nécessitant une prise en charge intensive. Malgré son caractère rétrospectif, ce travail fournit des données importantes pour améliorer la connaissance du paludisme grave d importation de l enfant en France. Ces résultats doivent être confirmés par des études complémentaires prospectives.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocPARIS-Bib. Serv.Santé Armées (751055204) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Révolution dans le traitement de la mucoviscidose

Cystic Fibrosis is a genetic disorder resulting in the absence or dysfunction of the CFTR protein, a chloride channel present on the surface of epithelia, particularly respiratory. Until recently, treatments only concerned the consequences of the disease. But a new type of molecules called « modulators », is already available to some patients and targets the origin of the disease. « Modulators » are divided into « potentiators », which improve the transport of chloride by the CFTR protein, and « correctors », increasing the amount of CFTR proteins. An oral triple therapy combining a potentiator and two correctors has just been approved in the USA and will treat 85 % of patients. The clinical benefit of « modulators » is remarkable, and these drugs are revolutionizing the treatment of Cystic Fibrosis

Severe imported malaria in children in France. A national retrospective study from 1996 to 2005

the Pediatric Imported Malaria Study Group for the ‘Centre National de Référence du Paludisme'International audienceBackgrounds: Malaria is a leading cause of imported febrile illnesses in pediatric travelers, but few studies have addressed severe imported pediatric malaria. We aimed to determine the risk factors and the features of imported pediatric severe malaria.Methods: We conducted a retrospective, descriptive study using the French National Reference Center for Imported Malaria database, in children aged 0–15 years who were hospitalized with a falciparum malaria from January 1st 1996 to December 31th 2005. Uncomplicated and severe cases of falciparum malaria were compared to identify risk factors for severe cases. In the hospitals that reported more than five severe cases during the study period, we evaluated severe cases for prognostic factors and assessed the accuracy WHO criteria for predicting severity. Given the rarity of deaths, adverse outcomes were defined as requiring major therapeutic procedures (MTPs)—e.g., sedation, mechanical ventilation, nasal oxygen therapy, blood transfusions, hemodialysis, fluid resuscitation—or pediatric intensive care unit (PICU) admission.Results: Of 4150 pediatric malaria cases included in the study, 3299 were uncomplicated and 851 (20.5%) were severe. Only one death was recorded during this period. Predictors for severe falciparum malaria were: age <2 years (OR = 3.2, 95% CI = 2.5–4.0, p <0.0001) and a travel in the Sahelian region (OR = 1.7, 95% CI = 1.3–2.0, p = 0.0001). Of 422 severe malaria cases, a stay in a Sahelian region, lack of chemoprophylaxis, age <2 years or thrombocytopenia <100 x 10^3/mm^3 predicted adverse outcomes. Except for the hyperparasitemia threshold of 4%, the main WHO 2000 criteria for severe malaria reliably predicted adverse outcomes. In our study, the threshold of parasitemia most predictive of a poor outcome was 8%.Conclusion: In imported pediatric malaria, children younger than 2 years deserve particular attention. The main WHO 2000 criteria for severity are accurate, except for the threshold of hyperparasitemia, which should be revised

Sensitivity (Se), specificity (Spe), positive (PPV) and negative (NPV) predictive values of the WHO 2000 severity criteria for the use of Major Therapeutic Acts (Table 4A) in 422 children admitted for severe malaria in metropolitan France between 1996 and 2005.

<p>Sensitivity (Se), specificity (Spe), positive (PPV) and negative (NPV) predictive values of the WHO 2000 severity criteria for the use of Major Therapeutic Acts (Table 4A) in 422 children admitted for severe malaria in metropolitan France between 1996 and 2005.</p

Predictors for the occurrence of severe cases in 4150 children hospitalized with malaria in mainland France, 1996–2005.

<p>Predictors for the occurrence of severe cases in 4150 children hospitalized with malaria in mainland France, 1996–2005.</p

Flow chart of the study: First, comparison between severe and uncomplicated cases registered in the national pediatric database of CNR du paludisme, then research on severe cases in the medical records of hospitals from Region Île-de-France and the city of Marseilles having declared more than 5 severe malaria cases during the period 1996–2005.

<p>Flow chart of the study: First, comparison between severe and uncomplicated cases registered in the national pediatric database of CNR du paludisme, then research on severe cases in the medical records of hospitals from Region Île-de-France and the city of Marseilles having declared more than 5 severe malaria cases during the period 1996–2005.</p

Univariate and Multivariable analysis: Predictive factors for the use of major therapeutic procedures in 368 children admitted for severe imported malaria in mainland France, 1996–2005.

<p>Univariate and Multivariable analysis: Predictive factors for the use of major therapeutic procedures in 368 children admitted for severe imported malaria in mainland France, 1996–2005.</p

Sensitivity (Se), specificity (Spe), positive (PPV) and negative (NPV) predictive values of the WHO 2000 severity criteria for the admission in PICU in 422 children admitted for severe malaria in metropolitan France between 1996 and 2005.

<p>Sensitivity (Se), specificity (Spe), positive (PPV) and negative (NPV) predictive values of the WHO 2000 severity criteria for the admission in PICU in 422 children admitted for severe malaria in metropolitan France between 1996 and 2005.</p

Distribution of main characteristics of children with uncomplicated or severe forms of imported malaria in mainland France, 1996–2005.

<p>Distribution of main characteristics of children with uncomplicated or severe forms of imported malaria in mainland France, 1996–2005.</p