A. Sammoud

Neurological Variant of Lemierre's Syndrome with Purulent Meningitis: A Case Report and Literature Review

We report an unusual variant of Lemierres Syndrome (LS) in a 10-year-old-girl admitted to the intensive care unit for septic shock with meningitis. The primary infection was otitis media. A gram negative bacillus was identified in the direct exam of the purulent ear discharge and the cerebrospinal fluid but cultures were negative. Computerized tomography of the neck revealed a thrombus in the internal jugular vein. Septic shock improved rapidly under supportive treatment. The patient recovered without sequellae after a prolonged duration of parenteral antibiotherapy and hospital stay. Neurologic variants of LS with meningitis, previously reported in the literature, are reviewed.

Méningite bactérienne iatrogène après ponction lombaire de diagnostic: à propos de trois cas observés à l’hôpital d’enfants de Tunis

We have collected cases of iatrogenic meningitis managed in the Childrens Hospital of Tunis, between January 1998 and December 2006. Clinical information about each patient were collected, all bacterial samples were investigated in the microbiology laboratory of the hospital. Bacterial isolates were identified according to conventional criteria. In the interval under study, we recorded three cases of iatrogenic meningitis after lumbar puncture. Two cases occurred in newborn admitted for suspicion of neonatal infection and one in a 2-month-old infant admitted for exploration of hyperpyretic convulsion. In all patients, the initial cerebrospinal fluid was normal. All patients developed symptoms of acute meningitis within 72 hours after lumbar puncture; the second cerebrospinal fluid was, then, typical for purulent meningitis. The causal agents isolated in the three cases were Klebsiella pneumoniae, Enterobacter cloacae, and Serratia marcescens, all resistant to beta-lactams by extended spectrum beta-lactamase production. The use of quinolones was required in all cases. Different complications were recorded: hydrocephalus and brain abscess in one case, respiratory and hemodynamic failure managed in the intensive care unit in the second, and brain hygroma in the third case. This study shows high morbidity of iatrogenic meningitis. Simple aseptic precautions undertaken before the procedure of lumbar puncture can prevent such cases. The urgent need for increasing the awareness among medical personnel in hospitals of developing countries cannot be overemphasized.

Serum leptin concentration in Tunisian non overweight non obese children

Leptin, an adipocyte-derived peptide hormone, is thought to play a key role in the regulation of body fat mass. Beyond this function, it appears to be an integral component of various hypothalamo-pituitary-endocrine feedback loops. Because childhood and puberty are periods of major metabolic and endocrine changes, we investigated leptin levels in 348 non overweight, non obese children (147 boys, 201 girls, age: 6-12 years) and then correlated these levels with age, anthropometric data, pubertal stage and insulin. A blood sample was collected from each subject to measure leptin and insulin levels by radioimmunoassay. Pubertal stage was assigned by physical examination, according to Tanner criteria for breast development in females and genital development in males. The results showed an increase in leptin levels in an age related way (r = 0.32, p < 0.0001 in girls; r = 0.21, p = 0.011 in boys) following a pattern that paralleled body weight (r = 0.6 in girls; r = 0.56 in boys; p < 0.0001) and BMI (r = 0.59 in girls; r = 0.6 in boys, p < 0.0001), suggesting that body fatness is a regulator of leptin levels in both girls and boys. A significant gender difference (3.39 +/- 2.79 ng/mL in girls vs 1.99 +/- 2.08 ng/mL in boys, p < 0.0001) with an increase during pubertal development in girls was also showed, while the levels remained constant in boys from Tanner stages T1 to T3. A correlation between leptin and insulinemia was noted in girls (r = 0.38, p < 0.0001) but not in boys, suggesting that insulinemia could be a stimulator of leptin synthesis in girls.

Inadequate Breastfeeding may lead to Severe Hypernatremia: A Case Report

Background: The benefits of breast feeding are well established worldwide. Inadequate breastfeeding may result in severe complications such as hypernatremic dehydration. This condition is rare and not well known. In this case report, we describe a case of severe hypernatremic dehydration revealed by fever with delayed consultation. Presentation of case: We report the case of an exclusively breastfed male newborn. He was referred on the 13th day of life because of lethargy and fever. He had a severe dehydration on clinical examination. Serum sodium was of 172 mmol/L. The breast milk sodium was high as compared to a volunteer control (85 mmol/L vs 19 mmol/L). Breastfeeding was temporarily suspended and reintroduced after 5 days with favorable evolution. Conclusion: Breast feeding associated hypernatremia can cause life-threatening complications in newborns. Prevention requires frequent and sufficient breastfeeding and weight gain monitoring during the first days of life.

Correction to: Full title: peripheral venous catheter complications in children: predisposing factors in a multicenter prospective cohort study

Following publication of the original article [1], one of the authors flagged that the title of the article was submitted (incorrectly) with “Full title:” at the beginning.

Reversible posterior leukoencephalopathy syndrome: A rare complication of hypertensive encephalopathy in children

Reversible posterior leukoencephalopathy syndrome is a recently defined cliniconeuroradiologic entity, rarely reported in children. Hypertensive encephalopathy is the most common cause. A 4-year-old boy presented with reversible posterior leukoencephalopathy syndrome manifested by headache, seizures, coma, papilledema and facial paralysis complicating severe arterial hypertension. Computed tomography scan of the brain showed bilateral low-density areas corresponding to the frontal, parietooccipital white matter and to the internal capsula. Blood pressure was controlled within 4 days and clinical recovery was obtained within 5 days. Magnetic resonance imaging, performed 2 months later, was normal. The arterial hypertension was caused by renal scars of bilateral vesico-renal reflux. The clinical course, pathophysiology and neuroimaging features of reversible posterior leukoencephalopathy syndrome in children are discussed.

Méningite bactérienne iatrogène après ponction lombaire de diagnostic : à propos de trois cas observés à l'hôpital d'enfants de Tunis Iatrogenic meningitis after diagnosis lumbar puncture: 3 cases reports in the paediatric Children's Hospital of Tunis

We have collected cases of iatrogenic meningitis managed in the Childrens Hospital of Tunis, between January 1998 and December 2006. Clinical information about each patient were collected, all bacterial samples were investigated in the microbiology laboratory of the hospital. Bacterial isolates were identified according to conventional criteria. In the interval under study, we recorded three cases of iatrogenic meningitis after lumbar puncture. Two cases occurred in newborn admitted for suspicion of neonatal infection and one in a 2-month-old infant admitted for exploration of hyperpyretic convulsion. In all patients, the initial cerebrospinal fluid was normal. All patients developed symptoms of acute meningitis within 72 hours after lumbar puncture; the second cerebrospinal fluid was, then, typical for purulent meningitis. The causal agents isolated in the three cases were Klebsiella pneumoniae, Enterobacter cloacae, and Serratia marcescens, all resistant to beta-lactams by extended spectrum beta-lactamase production. The use of quinolones was required in all cases. Different complications were recorded: hydrocephalus and brain abscess in one case, respiratory and hemodynamic failure managed in the intensive care unit in the second, and brain hygroma in the third case. This study shows high morbidity of iatrogenic meningitis. Simple aseptic precautions undertaken before the procedure of lumbar puncture can prevent such cases. The urgent need for increasing the awareness among medical personnel in hospitals of developing countries cannot be overemphasized.