Obturator externus abscess in a 9-year-old child: A case report and literature review.

Obturator pyomyositis is a rare condition in children. Diagnosis is often delayed because of its rarity, and the vagaries of its presentation cause it to be easily be missed. Physicians should therefore familiarize themselves with this condition and consider it as a possible differential diagnosis in patients presenting with an acutely painful hip. Inflammatory syndrome is also frequent among sufferers and the MRI is a very sensitive diagnostic tool for obturator pyomyositis. Additionally, joint fluid aspirations and blood cultures are also useful in identifying the pathogen. The appropriate antibiotic therapy provides a rapid regression of symptoms during the early stage of pyomyositis. In cases of MRI-confirmed abscess, surgical treatment is indicated. Our report focuses on a case of obturator pyomyositis in a 9-year-old boy. The child was febrile for 5 days and could only manage to walk a few steps. His hip range of motion was restricted in all directions. In addition, the patient had presented pain and swelling of his right elbow for a day, with a restriction of motion in the joint. There was a clear inflammatory syndrome. A diagnosis of hip and elbow septic arthritis was suspected, and the child underwent joint aspiration of the both cited joints. The aspiration of the elbow returned pus. Conversely, no effusion was found in the hip aspiration. The administration of empiric intravenous antibiotherapy was started. An MRI revealed an osteomyelitis of the ischio-pubic area associated with a subperiosteal abscess. Subsequently, 3 days after elbow arthrotomy, a surgical treatment was performed on the patient's right hip in order to evacuate the subperiosteal abscess and muscular collection because of the persistence of the patient's symptoms and inflammatory syndrome despite susceptible intravenous antibiotics. Postsurgery the patient showed steady improvement. Such cases demonstrate how diagnosis can be difficult because pelvic pyomyositis is often mistaken for more common pathologies such as septic arthritis, osteomyelitis, or appendicitis. This may delay the diagnosis or refer misdiagnosis. We discuss this rare infection in light of the literature with particular reference to its incidence, clinical features, bacteriological etiology, biological, and radiological presentation, and above all, its treatment

Adapting response to a measles outbreak in a context of high vaccination and breakthrough cases: an example from Vaud, Switzerland, January to March 2024.

A measles outbreak with 51 cases occurred in the canton of Vaud, Switzerland, between January and March 2024. The outbreak was triggered by an imported case, and 37 (72.5%) subsequent cases were previously vaccinated individuals. Epidemiological investigations showed that vaccinated measles cases were symptomatic and infectious. In a highly vaccinated population, it is important to raise awareness among healthcare professionals to suspect and test for measles virus when an outbreak is declared, irrespective of the vaccination status of the patients

Fièvre persistante chez l’enfant de retour de voyage [Persistent fever in the travelling child]

Persistent fever or FUO (fever of unknown origin) is defined by a fever of more than 1‑2 weeks that remains unexplained, after considerable diagnostic efforts. In the travelling child, in addition to cosmopolitan infectious diseases, tropical pathogens must absolutely be considered according to the regions visited and the activities practiced. A detailed history and a complete clinical examination are essential to decide which supplementary investigations will complete the basic assessment, which must contain the search for malaria in any child who has visited an endemic area. Following the diagnostic strategy proposed in this article, the clinician should be able to diagnose the most common diseases

SARS-CoV-2 et enfants : épidémiologie, présentation clinique et contagiosité [SARS-CoV-2 in children: epidemiology, clinical presentation and contagiosity]

Children are under-represented in terms of the frequency and severity of COVID-19 disease. Although the proportion of children tested positive remains much lower than that of adults suggesting that they are less susceptible to SARS-CoV-2 infection, seroprevalence studies are contradictory in this regard. With respect to the role of children in transmission of the virus, no biological reason for reduced infectivity has been found. However, in the community, children rarely seem to be the vectors of this infection. With regard to adolescents, epidemiological data and their behavior similar to that of young adults suggest that they contribute to the spread of the virus more effectively than younger children

Vaccination chez l’adulte: vaccins contre le zona et vaccination en cas d’asplénie anatomique ou fonctionnelle [Vaccination in adult patients: shingles vaccines and vaccination in case of anatomical or functional asplenia]

Shingles vaccination and pneumococcal vaccination of patients with celiac disease are among the most recent updates for the vaccination of vulnerable adults, in Switzerland. Shingles and especially post-herpes zoster pain remain an unresolved public health issue. The only vaccine available in Switzerland is very little administered because it is not reimbursed by health insurance companies. A second shingles vaccine is announced for 2022 and should help to reduce the burden of this disease. It has been known for many years that celiac disease is accompanied by hyposplenism in adults. The resulting increased risk of invasive pneumococcal infections justifies, since 2020, a recommendation for vaccination against these encapsulated bacteria

Toxoplasmose et cytomégalovirus congénitaux en Suisse en 2019 [Congenital Toxoplasmosis and CMV in Switzerland in 2019]

Epidemiological trends in congenital toxoplasmosis and CMV are extremely divergent. While there were only 39 cases of congenital toxoplasmosis in Switzerland between 1982 and 2015, there was an equivalent number of cases of congenital CMV, 38 in total, in 2017 alone. Serological screening for toxoplasmosis was logically abandoned in Switzerland in 2008. Regarding CMV, there is no recommendation for serological screening or neonatal screening in Switzerland, whereas early diagnosis can improve prognosis through the rapid initiation of antiviral treatment. The epidemiological data generated by sentinel surveillance of congenital CMV infections in Switzerland may or may not justify such a measure in our country in the future

Meningococcal serogroup W135 epiglottitis in an adolescent patient.

Acute epiglottitis is a severe and potentially life-threatening condition. Since the implementation of javax.xml.bind.JAXBElement@1aa5699 vaccination, the number of cases of epiglottitis has decreased and the proportion of other infectious causes has increased. We report a case of acute epiglottitis in a teenager caused by javax.xml.bind.JAXBElement@32cd1494 , an unusual pathogen

Evidence-based optimisation of empirical antibiotic regimens in paediatric complicated appendicitis: a retrospective study of 94 patients.

Acute appendicitis is the most frequent surgical emergency in the paediatric population. Complicated appendicitis accounts for 30% of cases and is inextricably linked to postoperative infectious complications. A study at our institution showed that amoxicillin-clavulanate resistant Escherichia coli in complicated appendicitis was significantly linked to postoperative infectious complications. These findings led to a change in the empirical antibiotic protocol (amoxicillin-clavulanate changed to ceftriaxone + metronidazole as of 2017), intending to reduce postoperative infectious complications in complicated appendicitis in our institution. This study aimed to analyse the microbiology and resistance profiles of pathogens of complicated appendicitis at our institution since implementing the new antibiotic protocol and the postoperative infectious complications rate. We designed a retrospective comparative cohort study. During the defined study period (01 January 2017 to 31 July 2020), medical records were analysed for cases of acute appendicitis, complicated appendicitis and postoperative infectious complications, retaining only those who fulfilled inclusion criteria. Postoperative outcomes, microbiology and antibiotic resistance of peritoneal swabs were analysed. During the study period, 95 patients presented with a complicated appendicitis, and 11 (12%) developed postoperative infectious complications. The most frequent pathogens found in complicated appendicitis were E. coli (66%), Streptococcus anginosus (45%), and Bacteroides fragilis (22%). Pseudomonas aeruginosa was present in 17% of complicated appendicitis. Pathogens involved in postoperative infectious complications mirrored the distribution found in complicated appendicitis without postoperative infectious complications. Antibiotic susceptibility analysis showed that 10 (15%) of E. coli strains were resistant to amoxicillin-clavulanate but sensitive to ceftriaxone + metronidazole, with only one strain responsible for causing a postoperative infectious complication. Six additional strains of E. coli (9%) were resistant to amoxicillin-clavulanate and our empirical antibiotic regimen but were not associated with an increase in postoperative infectious complications. Compared with our previous study, there was a decrease in postoperative infectious complications from 16% to 12%. Postoperative infectious complications caused by amoxicillin-clavulanate-resistant E. coli decreased from 28% to 9%. This retrospective study demonstrated a decrease in the rate of postoperative infectious complications due to amoxicillin-clavulanate-resistant E. coli in complicated appendicitis. These findings accentuate the need to implement evidence-based treatment protocols based on local microbiology profiles and resistance rates to optimise post-operative antibiotics in complicated appendicitis

Vaccination ROR à l’UNIL et à l’EPFL : les étudiant·e·s en médecine de Lausanne se mobilisent [MMR vaccination at UNIL and EPFL : Lausanne medical students get involved]

In recent years, several cases of measles have appeared on the campuses of the University of Lausanne (UNIL) and the Swiss Federal Institute of Technology in Lausanne (EPFL). In response to this, several medical students have mobilized in collaboration with various cantonal authorities in order to set up a free measles, mumps and rubella vaccination campaign on the UNIL/EPFL campuses, in 2019. This first edition was a success and will be repeated in the future. Such an approach having shown its feasibility, it could be applied to other public health issues. The involvement of medical students could thus be extremely valuable if a generalized vaccination against SARS-CoV-2 were to take place