L’infection néonatale secondaire à Salmonella typhimurium est rare et peut revêtir des aspects cliniques variables pouvant aller jusqu’au sepsis grave souvent mortel. L’objectif de ce travail est d’étudier les aspects cliniques, bactériologiques et évolutifs de l’infection néonatale à S. typhimurium productrice de bêtalactamases à spectre élargi (BLASE+), au moyen d’une étude rétrospective sur une durée de trois ans incluant cinq observations. Tous les cas étaient en provenance du même hôpital provincial. L’âge moyen était de 16 jours. La symptomatologie principale était liée à un tableau de déshydratation aiguë. Le bilan bactériologique a objectivé un S. typhimurium BLSE+ chez tous les cas. La prise en charge thérapeutique a reposé sur une antibiothérapie adaptée à l’antibiogramme, associée à un traitement symptomatique. L’évolution fut favorable dans quatre cas et fatale pour un seul patient en raison d’un sepsis extrêmement sévère. Bien que les céphalosporines de troisième génération soient le traitement de référence, l’émergence de souches de plus en plus résistantes rend indispensable l’adaptation de l’antibiothérapie à l’antibiogramme du germe isolé.
Background Systemic juvenile lupus erythematosus can affect any organ including the heart. While pericarditis and endocarditis are the most common cardiac complications, dilated cardiomyopathy remains rare. We report the full recovery of dilated cardiomyopathy in a girl with juvenile lupus. Case presentation A 7-year-old girl presented with persistent fever, weight loss, alopecia, positive anti-lupus antibodies, and decreased complement. Examination found dyspnea, tachycardia, and hypotension. Chest X-ray revealed an enlarged cardiac silhouette, and echocardiography showed a left ventricular ejection fraction of 35%. After excluding other causes, systemic lupus erythematosus related dilated cardiomyopathy was selected. Heart failure treatment, Prednisone, and hydroxychloroquine were prescribed. On day three, she developed macrophage activation syndrome which responded to methylprednisolone boluses. Clinical and biological improvement was observed after 4 weeks, normalization of echocardiography after 4 months. Conclusion A review of the literature confirmed the rare and severe nature of dilated cardiomyopathy in juvenile lupus emphasizing the importance of performing echocardiography at the slightest cardiac sign.
Background: Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease that can affect any organ in the body, nonetheless cardiac involvement is frequent. Pericarditis is the most common type of heart attack followed by endocarditis, whereas myocarditis is rare. Despite improvements in the survival and quality of life of children with SLE, morbidity from the disease continues to be a major cause of death. Over the past three decades, lupus-related mortality has declined in all categories except cardiovascular disease. Heart disease is currently recognized as a major cause of death and morbidity in children with SLE. In fact, in the majority of cohort studies, the mean cardiovascular mortality is between 7 and 30%. We report full recovery of a little girl with SLE who developed dilated cardiomyopathy and review the literature. Case presentation: A 7-year-old girl presented with persistent fever, severe weight loss, alopecia, purpuric spots, positive anti-lupus antibodies, and decreased complement. She was diagnosed with SLE and treated with oral corticosteroids and hydroxychloroquine. On the third day of hospitalization, she developed a macrophage activation syndrome which improved with the methylprednisolone bolus. Additional examinations have been performed, including chest x-ray and echocardiography. They showed respectively marked enlargement of the cardiac silhouette and dilated cardiomyopathy with a left ventricular ejection fraction (LVEF) of approximately 35% associated with low pericardial effusion. She was diagnosed with SLE-related dilated cardiomyopathy and treated with furosemide, captopril, digoxin, spironolactone, and acetyl-salicylic acid. Clinical improvement was observed and the echocardiographic examination after 4 months of evolution was normalized, allowing cardiac treatments to be stopped while maintaining captopril.Conclusions: It is mandatory to check cardiac involvement in all patients with pediatric lupus to make an early diagnosis and ensure optimal management of cardiomyopathy, which is a rare, severe and silent complication.
Background Juvenile systemic lupus erythematosus is a multisystem inflammatory autoimmune disease affecting patients under 16 years old. Diagnosis may be difficult because of the large clinical heterogeneity. Classification criteria are important to ensure a clear definition and consistent inclusion of patients in clinical trials. The objective of the work: is to Compare the performance of the classification criteria of the American College of Rheumatology (ACR 1997), those of the Systemic Lupus International Collaborating Clinics (SLICC 2012) and the new classification criteria together with the European League Against Rheumatism “EULAR” and the American College of Rheumatology “ACR” (EULAR/ACR 2019). Methods This is a cross-sectional retrospective study carried out in a tertiary care service over a period of one year, from January 1, 2020 to December 31, 2020. The patients were subjected to the different classification criteria ACR 1997, SLICC 2012 and EULAR/ACR 2019. All our patients were matched in age and sex with control cases followed for inflammatory disease (12 control cases). Results Six patients were diagnosed with juvenile systemic lupus erythematosus (JSL) over the period of our study. A clear predominance of women was noted with a sex ratio of 5 girls/1 boy. The mean age at the time of diagnosis was 9 years (extremes: 3 –12 years). The diagnosis was made after an average delay of 5 months (extremes: 1–12 months). All of our patients met the three classification criteria. Sensitivity to all criteria was noted at diagnosis and during the first months of follow-up with higher sensitivity for SLICC criteria. Regarding the control cases, 3 patients met the ACR 1997 criteria. Conclusion In this population of Juvenile systemic lupus erythematosus, the SLICC criteria gave the best results in terms of sensitivity and precision at the time of diagnosis and during the first months of follow-up, while the ACR 1997 criteria were less specific.
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