Pierre Goussard

GeneXpert MTB/RIF on bronchoalveolar lavage samples in children with suspected complicated intrathoracic tuberculosis: a pilot study.

Children with complicated intrathoracic tuberculosis (TB) require rapid confirmation of TB diagnosis and of drug susceptibility to institute appropriate therapy. In a pilot study, we evaluated the feasibility and potential utility of GeneXpert (Xpert) on bronchoalveolar lavage (BAL) samples in children undergoing routine diagnostic bronchoscopy.

Meningococcal purpura fulminans treated with medicinal leeches

Introduction: Meningococcal septicemia remains one of the most common infectious causes of admission to a pediatric intensive care unit. Numerous treatment strategies aimed at the thromboembolic complications inducing purpura fulminans and limb/digital ischemia have been attempted, with variable results. The successful use of medicinal leeches for pneumococcal purpura fulminans has been described, and we present a similar case of meningococcal purpura fulminans. Patient and Intervention: A 5-wk-old female infant with meningococcal meningitis and septicemia and progressive purpura fulminans of the left hand was treated with medicinal leeches. Medicinal leeches were applied to the left dorsal hand on a daily basis for 4 consecutive days. Result: The swelling and limited functionality visibly improved after 48 hrs, and by 120 hrs, perfusion in the distal phalanges of the thumb and middle finger was evident. Reperfusion of the distal phalanges was not fully sustained, and at 6 wks the plastic surgery department debrided the distal phalanges of her left hand, excluding the thumb. She fully recovered from the meningococcal septicemic shock; the functionality of her left thumb was preserved, and she has limited functionality of her left hand. Conclusion: The unique combination of salivary products in leech therapy has theoretical benefits and requires future study.

Lymphomatoid granulomatosis: A rare cause of cavitatory lung disease in an HIV positive child

We present an unusual cause of lung cavitation and a neck mass in an HIV positive child, initially thought to be tuberculosis. This case report illustrates that the cause for cavitatory lung disease in immunosuppressed children has a large number of possibilities and careful investigation to determine the etiological agent is warranted. Pediatr Pulmonol. 2013; 48:202–205.

Organic foreign body causing lung collapse and bronchopleural fistula with empyema.

A 10-month-old infant presented with cough and fever. Treatment with oral antibiotics was initiated but the infant was admitted to hospital 7u2005days later, severely ill with a high-swinging fever. On clinical examination of the chest there were reduced breath sounds in the area of the right lower lobe.nnThe initial chest X-ray (figure 1A) taken on admission to hospital demonstrated right-sided pleural effusion as well as parenchymal opacities of the right lower lung region. Although the chest X-ray was rotated to the right there was a suggestion that the mediastinum was displaced to the left.nnnnFigurexa01 n(A) Initial chest X-ray examination. There are ill-defined pleural-based densities involving the right hemithorax as well as underlying parenchymal air-space disease with air bronchograms and loss of the diaphragmatic and right cardiac margins. There is mediastinal shift even in the presence of rotation to the right, which disguises this to a degree. There are no pleural air-pockets or pneumothorax on this radiograph. (B) Postoperative chest X-ray demonstrates significant improvement with …

Rare cause of an anterior mediastinal mass causing airway compression in a young child.

A 1-year-old female child presented with recurrent chest infections and a tracheal cough. She had been previously well with no known tuberculosis contacts. The child had distended neck veins but not any facial plethora. Chest X-ray demonstrated a large anterior mediastina mass extending into the right hemithorax. The trachea was compressed and displaced to the left, while the carina was depressed and splayed (figurexa01A). Post-contrast axial CT scan (figure 2A, B) demonstrated a homogenous, non-enhancing soft tissue mediastinal mass of visibly lower density than muscle, predominantly in the right paratracheal position. There were no calcifications noted. The mass encased the superior vena cava and right subclavian artery, as well as displacing the trachea and carina from their position on the thoracic spine. The trachea was significantly narrowed (‘circumferentially’) as compared to the right and left main bronchi. The thymus appeared visibly normal. A soft tissue biopsy was performed via …

A correctable cause of lung collapse in an adolescent with severe scoliosis causing compression of the bronchial tree

A 17-year-old boy with known severe cerebral palsy presented with cough, fever and shortness of breath. He was a spastic quadriplegic with muscle weakness, severe scoliosis and poor cough which made it difficult for him to clear respiratory secretions. He presented with acute pneumonia which resulted in progressive respiratory failure requiring intubation and ventilation. The initial plain chest radiograph (figure 1A) demonstrated severe scoliosis and mediastinum shift to the right. On following the airways an abrupt cut-off of bronchus intermedius at the level where it crossed the vertebral column was seen. This resulted in a collapse of the right middle and lower lobes, further compromising the respiratory compromise. On X-ray, the curve measured 107° according to the Cobb method.nnnnFigurexa01 n(A) Preoperative plain radiographs of the spine …

Infantile intrathoracic large airway obstruction in a setting with a high prevalence of tuberculosis/HIV

Abstract Background There has been no detailed analysis of the cause of intrathoracic large airway obstruction in infants in a resource-limited environment with a high prevalence of pulmonary tuberculosis (PTB) and human immunodeficiency virus (HIV). Aim To define the aetiology and severity of intrathoracic large airway obstruction in infants in a tertiary South African hospital with a high prevalence of PTB and HIV. Methods A retrospective study of infants was conducted with computerised tomography (CT) evidence of intrathoracic large airway obstruction from 1 January 2011 to 31 May 2014. CT scans were evaluated for the cause, site and severity of airway narrowing, with severity stratified as ‘mild’ (<50%), ‘moderate’ (51–75%) or ‘severe’ (>75%). Results Forty-four patients (28 males, 64%; median age 145 days, range 5–331), and 79 sites of attenuation were included. Vascular (22/44, 50%) and nodal (18/44, 41%) compressions accounted for over 90% of cases. Thirty-five patients (79.5%) had at least one site of moderate/severe attenuation, and 26 (59%) had multiple such sites. Adenopathy was the commonest cause of moderate/severe compression (18/35, 51%). All cases of nodal compression were of tuberculous origin. HIV-serology was recorded in 32 patients (73%), one of whom, with vascular compression, was HIV-infected. Half of the patients (11/22, 50%) with vascular compression had congenital abnormalities, most commonly cardiac anomalies (7/22, 32%). There were no synchronous vascular and nodal compressions. Conclusion Infantile intrathoracic large airway obstruction where there is a high prevalence of PTB and HIV is characterised by its extrinsic aetiology, severity and multicentricity, with more than half of all moderate/severe obstructions being caused by tuberculous adenopathy.

Whole-genome sequence of a Mycobacterium goodii isolate from a pediatric patient in South Africa

ABSTRACT We describe here the draft genome sequence of a Mycobacterium goodii isolate from a pediatric patient in Western Cape, South Africa. To our knowledge, this is the second reported genome of this rapidly growing nontuberculous mycobacterial species.

HIV-related chronic lung disease in adolescents: are we prepared for the future?

ABSTRACT Introduction: Chronic lung diseases (CLD) are the most chronic disease occurring in adolescents living with human immunodeficiency virus (ALHIV). In ALHIV who received antiretroviral therapy (ART) late in childhood, bronchiectasis, bronchiolitis obliterans and interstitial pneumonitis are common. In adolescents who received ART early in life the spectrum of CLD has changed with asthma and chronic obstructive pulmonary disease being common. Areas covered: The aim of this paper was to review CLD in ALHIV. We conducted a literature review of electronic databases focusing on CLD that were common prior to the introduction of ART (1996–2004), the present situation where ART is widely available (2005 to 2016), and articles which aided us speculating on the impact of HIV-related CLD in adolescents transitioning to adult HIV-clinics. Amongst the approximately 2.1 million adolescents living with HIV, CLD commonly occurs. Awareness of the CLD amongst ALHIV needs to be raised to ensure that disease appropriate treatment is available to these vulnerable adolescents. Expert commentary: As adolescents’ transition from pediatric HIV-clinics to adult HIV-clinics the evidence shows that adolescents might not receive optimal care if adult pulmonologists are not aware of the CLD that commonly occur in ALHIV.

Loculated empyema due to tuberculosis in a child

A 9-year-old girl from black ethnic origin presented with a history of fever, cough, loss of weight and right-sided chest wall pain for 2 weeks. Chest X-ray demonstrated an effusion, which was shown to be loculated on chest CT scan. She was not responding to medical treatment and at thoracotomy loculated pus was drained. Mycobacterium tuberculosis (TB) was cultured from the pus. TB is a rare cause of loculated empyema with an overlapping clinical and radiological picture with pyogenic infections.