Aida Borgi

Datura stramonium L. poisoning in a geophagous child: a case report

Datura stramonium L. (DS) is a wild-growing plant widely distributed and easily accessible. It contains a variety of toxic anticholinergic alkaloids such as atropine, hyoscamine, and scopolamine. Voluntary or accidental ingestion can produce severe anticholinergic poisoning. We report an unusual case of DS intoxication occurring in a geophagous young child after accidental ingestion of the plant. Our case is original because of the young age of the victim and the underlying geophagia facilitating the occurrence of poisoning.

Rabies encephalitis in a child: a failure of rabies post exposure prophylaxis?

Rabies remains a serious public health problem in many developing countries. The diagnosis is easy when a non-immunised patient presents with hydrophobia and hypersalivation after a bite by a known rabid animal but more difficult when a patient presents atypical symptoms after having received rabies postexposure prophylaxis. Rabies postexposure prophylaxis failure is rare. We report a case of a 6-year-old boy who presented febrile seizure with agitation and cerebellar signs, without hydrophobia or hypersalivation, 17 days after a dog bite. Despite four doses of rabies vaccine and immunoglobulin, he died. Diagnostic confirmation of rabies encephalitis was made in post mortem on brain biopsies by fluorescent antibody technique.

Predictors of Mortality in Mechanically Ventilated Critical Pertussis in a low Income Country

Background Critical pertussis is characterized by severe respiratory failure, important leukocytosis, pulmonary hypertension, septic shock and encephalopathy. Aim To describe the clinical course of critical pertussis, and identify predictors of death at the time of presentation for medical care. Methodology Retrospective study conducted in children’s hospital Tunisian PICU between 01 January and 31 October 2013. Patients with critical pertussis confirmed by RT-PCR and requiring mechanical ventilation were included. Predictors of death were studied. Results A total of 17 patients was studied. Median age was 50 days. Mortality was 23%. Predictors risk of mortality were : high PRISM score (Pediatric Risk of Mortality Score) (p=0,007), shock (p=0,002), tachycardia (p=0,005), seizures (p=0,006), altered mental status (p=0,006), elevated WBC count (p=0,003) and hemodynamic support (p=0022). However, the difference did not reach statistical significance in comorbidity, pneumoniae, high pulmonary hypertension or exchange transfusion. Concomitant viral or bacterial co-infection was not related to poor outcome. Conclusion Young infants are at high risk to have critical pertussis. Despite advances in life support and the treatment of organ failure in childhood critical illness, critical pertussis remains difficult to treat.

Pseudotumoral cutaneous aspergillosis in chronic granulomatous disease, report of a pediatric case.

Abstract:Invasive aspergillosis is a life-threatening condition in patients with chronic granulomatous disease (CGD). Skin invasion by Aspergillus occurs most commonly by contiguity to a neighboring cavity. We describe an unusual case of invasive cutaneous aspergillosis presented as a large burgeoning tumor in a 4-year-old girl with CGD who underwent surgical treatment for bifocal osteomyelitis of the left leg. The skin invasion occurred 4 months after a “successful” treatment of invasive pulmonary aspergillosis. Atypical presentation and diagnostic difficulties are discussed. Invasive cutaneous aspergillosis may be polymorphic. The diagnosis should be considered early in the etiological investigation of any suspicious skin lesions in CGD even in uncommon aspects such as burgeoning tumors.

Community acquired methicillin-resistant Staphylococcus aureus preseptal cellulitis complicated by zygomatic osteomylitis, cavernous sinus thrombosis and meningitis in a healthy child.

We report a case of community-acquired meticillin-resistant Staphylococcus aureus (CA-MRSA) preseptal cellulitis complicated by zygomatic osteomyelitis, cavernous sinus thrombosis, meningitis, and necroziting pneumonia in a previously healthy two and half month old girl. This case exemplifies an aggressive and disseminated CA-MRSA infection with deep venous thrombosis in an infant without predisposing risk factors. The literature is reviewed and recommendations for management are provided.

Toxic epidermal necrolysis complicated by small bowel intussusception: a case report

Intestinal involvement in toxic epidermal necrolysis (TEN) has been identified only rarely. We report a case of TEN complicated by small bowel intussusception. The patient was a previously healthy 8-year-old boy who presented with TEN and extensive lesions, including up to 40% of the body surface area as well as conjunctival, oropharyngeal, respiratory, and genital mucosa. Rapidly after the onset of a constant rate of enteral feeding, he developed bilious vomiting, diarrhea, and significant abdominal distension. Abdominal sonography showed a small bowel intussusception. At abdominal exploration, an ileoileal intussusception was observed with a viable but inflamed bowel wall. Manual reduction was performed. During the postoperative clinical course, the patient was managed with total parenteral nutrition and local care of the skin and mucous membranes. Enteral feeding was introduced on the sixth postoperative day, and the child left the hospital 15 days after his admission. The association of TEN and small bowel intussusception has not been previously reported in the literature.

646 Impact of Ductal Size on Successful Medical Closure of Patent Ductus Arteriosus in Preterm Infants

646 Impact of Ductal Size on Successful Medical Closure of Patent Ductus Arteriosus in Preterm Infants

Perforated Meckel's Diverticulum in a Very Preterm Baby Revealed at Birth

Perforated Meckels diverticulum (MD) in a preterm baby is very rare. We report a case of a very preterm baby, born at 29-week gestation, with a birth weight of 1400 g, admitted in the third hour of life to our intensive care unit (ICU) for respiratory distress syndrome with abdominal distention. An abdominal radiograph showed a pneumoperitoneum. Laparotomy revealed Meckels perforation. The baby was discharged healthy at the age of 16 days. MD should be kept in mind as one cause of an acute abdomen in preterm neonates mimicking necrotizing enterocolitis. To our knowledge, our patient is the third reported case described in the literature and the first one revealed at birth.

PO-0265 Non Invasive Ventilation For Severe Bronchiolitis

Introduction Non-invasive ventilation (NIV) is a relatively new ventilatory mode that has been increasingly used in the acute setting over the past 15 years, demonstrating beneficial effects in the paediatric population with different types of respiratory failure. Objectives To examine whether infants with severe bronchiolitis could be managed with non-invasive ventilation (NIV) alone. To study the characteristics, clinical course and outcome of NIV patients. Patients and methods A retrospective analysis was made of infants with severe bronchiolitis in a Paediatric Intensive Care Unit admitted from 01/09/2011 to 31/01/2012 and from 01/09/2012 to 31/02/2013. One thousand and sixty-four infants with severe bronchiolitis were admitted. One thousand and two were invasively ventilated, seventy-two were treated with NIV. We aimed to examine the characteristics, clinical course and outcome for those who received NIV. Results Seventy-two patients, including 6 with apnea, were treated exclusively with NIV. The mean age was de 54,2 days ± 39,1 (8–221). The mean respiratory rate was 61 breaths/min ±16,7 (20–104). NIV was delivered by continuous (CPAP) in seven patients, bi-level (BiPAP) positive airway pressure in thirty-four infants and high-flow nasal cannula in thirty-one patients. Twenty-three failed to respond and were invasively ventilated. Risk factors for NIV failure were prematurity and bacterial infection. Duration of hospital stay was shorter in responders. There were no major complications related with NIV. Conclusion This study demonstrates the efficacy of NIV as a form of respiratory support for infants with severe bronchiolitis avoiding ETI in most of the patients. Risk factors for failure were related with immaturity and severe infection.

PS-213 Epidemiology And Outcome Of Neonatal Septic Shock In A Picu Of Tunisia

Background Neonatal septic shock is a devastating condition associated with high morbidity and mortality. Methods A retrospective study was conducted in children’s hospital Tunisian PICU between 2005 to 2013. All neonates (<28 days) treated for septic shock with bacterial proof were included. Nosocomial infection was an exclusion critéria. The chart review relieved demographics, length of stay, therapies and outcomes. Results A total of 40 neonates were included. Mean age on admission was 34 h±3.7. Mean SNAPP score was 25 ± 17. Materno-fetal infection was observed in 37 cases, staphylococcal pneumonia in 2 cases and bacterial coinfection with bronchiolitis in the last case. The bacteriological study showed a notable predominance of streptococcus B (40%) and E.coli (35%). All patients required mechanical ventilation (mean duration: 85 ± 556 h) and haemodynamic support (mean duration 49 ± 335 h). Mortality rate was 19% in full term infants, 12.5% in near term infants and 27% in extremely preterm infants. Conclusions Our results would indicate a high mortality rate in neonatal septic shock. A goal –directed therapy for septic shock, implanted in our PICU, could improve outcomes for this vulnerable population.