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Zuech P, de Raucourt E, Peltier J, Hayon Y, Beaufils F, Veyssier-Belot C. Syndrome des antiphospholipides et thrombopénie induite par l'héparine. Rev Med Interne 2002. [DOI: 10.1016/s0248-8663(02)80553-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bellaton E, Aizenfisz S, Saizou C, Baumann C, Beaufils F, Dauger S. [Trisomy 13 and neonatal hyperinsulinism]. Arch Pediatr 2002; 9:1210-1. [PMID: 12503517 DOI: 10.1016/s0929-693x(02)00099-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Beaufils F, Saizou C, Hurtaud MF, Gondon E, Auburtin B, Dauger S. [Thrombosis in the newborn]. Arch Pediatr 2002; 9 Suppl 2:137s-139s. [PMID: 12108246 DOI: 10.1016/s0929-693x(01)00894-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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55
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Kahn J, Zareski E, Veyssier-Bellot C, Piette J, Janowski M, Beaufils F. Péri-aortite au cours du lupus. Rev Med Interne 2001. [DOI: 10.1016/s0248-8663(01)80225-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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56
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Beaufils F. [Reply to the open letter from an urban pediatrician to his hospital colleagues]. Arch Pediatr 2001; 8:1270. [PMID: 11760685 DOI: 10.1016/s0929-693x(01)00644-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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57
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Mercier JC, Bingen E, Schlegel N, Elion J, Casanova JL, Mira JP, Beaufils F. [Meningococcal purpura fulminans: untoward result of genetic polymorphism?]. Arch Pediatr 2001; 8:843-52. [PMID: 11524916 DOI: 10.1016/s0929-693x(01)00529-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Despite significant progress in intensive care medicine, the mortality of septic shock has not changed in recent years. Early recognition of subtle signs in favor of meningococcal sepsis, early antibiotic treatment, and aggressive hemodynamic support remains the cornerstone of therapy of severe meningococcal shock in children. Recent work has emphasized the role of genetic polymorphisms in various systems to explain the most severe cases: anti-inflammatory cytokine profile IL-10/TNF-alpha, elevated levels of plasminogen activator inhibitor type-1, variants of the gene for mannose-binding lectin complement pathway. This may explain the disillusionment of pediatric intensivists, and the general failure of immunotherapy for sepsis. Reasonable hope lies upon new meningococcal vaccines.
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Auburtin B, Saizou C, Dauger S, Hartmann JF, Mercier JC, Beaufils F. [Prolonged length of stays in pediatric intensive care. Retrospective study of 100 stays]. Arch Pediatr 2001; 8:158-65. [PMID: 11232456 DOI: 10.1016/s0929-693x(00)00178-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED New issues have arisen in pediatric intensive care units, especially concerning long-stay patients. The aims of the present study were to describe the etiologic factors of these long-stay patients and to recognize the comorbidities. MATERIAL AND METHODS Ninety-five patients who had a total of 100 hospitalizations of more than 30 days were admitted to the pediatric intensive care unit at Robert-Debre Hospital during a 3-year period (1993-1995); this accounted for 9.1% of total admissions. We retrospectively reviewed these 100 long-stay hospitalizations. RESULTS Most of these patients were newborns (65%). Patients with severe congenital anomalies (44 patients) and very premature infants (26 patients) constituted the majority of long-stay patients. The mean duration of mechanical ventilation for the 95 patients was 110 days (ranges 17-789 days). Two factors of comorbidity were found: gastroesophageal reflux (41% of cases) and nosocomial infections (89% of cases). CONCLUSION In order to prevent long stays, pediatric intensive care units must be directed toward these factors.
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Le Thomas I, Mariani-Kurkdjian P, Collignon A, Gravet A, Clermont O, Brahimi N, Gaudelus J, Aujard Y, Navarro J, Beaufils F, Bingen E. Breast milk transmission of a Panton-Valentine leukocidin-producing Staphylococcus aureus strain causing infantile pneumonia. J Clin Microbiol 2001; 39:728-9. [PMID: 11158136 PMCID: PMC87805 DOI: 10.1128/jcm.39.2.728-729.2001] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report on a 38-day-old infant who developed pleuropneumonia due to a Staphylococcus aureus strain responsible for familial furunculosis, which was acquired by maternal breast-feeding. All isolates from the infant and parents were genetically related by randomly amplified polymorphic DNA analysis and produced Panton-Valentine leukocidin.
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Duboucher C, Farto-Bensasson F, Chéron M, Peltier JY, Beaufils F, Périé G. Lymph node infection by Trichomonas tenax: report of a case with co-infection by Mycobacterium tuberculosis. Hum Pathol 2000; 31:1317-21. [PMID: 11070125 DOI: 10.1053/hupa.2000.18502] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In an 82-year-old woman, presenting with fever and asthenia, cervical adenopathy was noted. Clinical and radiological investigations were fruitless. Laboratory examinations detected a refractory anemia. The lymph node was excised and showed numerous trichomonads on touch preparations. Histologically, the node showed caseous necrosis and macrophagic reaction. Diagnosis of lymph node infection by Trichomonas tenax was made. Three weeks later, culture of the node showed Mycobacterium tuberculosis and let us conclude co-infection. T tenax is usually regarded as a harmless saprophyte of the oral cavity. This exceptional observation shows for the first time an invasive potential of T tenax. It raises questions about links with tuberculosis and refractory anemia.
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Luton D, de Lagausie P, Guibourdenche J, Oury J, Sibony O, Vuillard E, Boissinot C, Aigrain Y, Beaufils F, Navarro J, Blot P. Effect of amnioinfusion on the outcome of prenatally diagnosed gastroschisis. Fetal Diagn Ther 1999; 14:152-5. [PMID: 10364666 DOI: 10.1159/000020910] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Following recent data showing that an inflammatory response exists in the amniotic fluid of gastroschisis-affected fetuses, we hypothesized that amniotic fluid exchange or amnioinfusion would improve the prognosis of prenatally diagnosed gastroschisis. METHODS We compared the outcome of prenatally amnioinfused fetuses with gastroschisis to non-amnioinfused fetuses with gastroschisis. 10 patients undergoing this procedure were matched with 10 patients of our previous study. Comparisons were done on data including surgical procedure, follow-up in the NICU and the gastro-pediatric unit. RESULTS Our results show that gastroschisis-affected fetuses undergoing amnioinfusion had a lower duration of curarization after surgery (2.2 +/- 1.9 vs. 6.8 +/- 6.9 days, p = 0.019), a shorter delay before full oral feeding (49.7 +/- 21.5 vs. 72.3 +/- 56.6 days, NS), and a shorter overall length of hospitalization (59.5 +/- 19.7 vs. 88.5 +/- 73.6 days, NS). We confirmed our previous data showing that amniotic fluid displays a chronic inflammation profile. CONCLUSION Our data suggest that amnioinfusion could improve the outcome of gastroschisis affected fetuses. The hypothesis by which this improvement could be due to a reduction of an inflammatory response remains to be proved.
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Beaufils F, Trang-Pham H, Gaultier C. [Congenital central alveolar hypoventilation syndrome, so-called "Ondine syndrome": an orphan disease, a disease of hope]. Arch Pediatr 1999; 6:383-5. [PMID: 10230476 DOI: 10.1016/s0929-693x(99)80218-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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64
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Dommergues JP, Bourrillon A, Gigonnet JM, Foucaud P, Beley G, Beaufils F. [What is the role today for general pediatrics?]. Arch Pediatr 1999; 6:243-5. [PMID: 10191887 DOI: 10.1016/s0929-693x(99)80258-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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65
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Thébaud B, Saizou C, Farnoux C, Hartman JF, Mercier JC, Beaufils F. [Congenital diaphragmatic hernia. II. Is pulmonary hypoplasia an indefinable obstacle?]. Arch Pediatr 1999; 6:186-98. [PMID: 10079889 DOI: 10.1016/s0929-693x(99)80208-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite major insights into the pathogenesis and pathophysiology of congenital diaphragmatic hernia, and despite the availability of an antenatal diagnosis and continuous progress in neonatal intensive care, little improvement has been obtained in the prognosis of this malformation. Thus obstetricians, neonatologists and pediatric surgeons are still facing a several dilemma: dilemma before birth to predict the prognosis, i.e., to evaluate the severity of the associated pulmonary hypoplasia in order to decide whether or not to interrupt pregnancy; dilemma after birth in case of severe respiratory failure to decide how far to go in life support. Based on a review of the literature and their own experience, the authors attempt to recapitulate the perinatal management and outcome of this severe malformation.
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Buffin A, Lehingue Y, Aurenche C, Beaufils F. [Pediatric activity in a rural hospital in Tokombéré (Cameroon). Description and qualitative approach during a one year period]. Arch Pediatr 1998; 5:1072-81. [PMID: 9809149 DOI: 10.1016/s0929-693x(99)80003-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To describe pediatric care in a North Cameroon rural hospital, the Health Promotion Centre of Tokombéré, and its coherence in a global project of development. POPULATION AND METHODS This prospective and descriptive study concerned all the children admitted from October 1993 to October 1994. Analysis of data from a questionnaire has been conducted with EPI-INFO. RESULTS Six hundred and thirty-one children were admitted. The average age was 3.9 years, the sex ratio was 1.45; the percentage of children coming from the Tokombéré health area was 75%. The predominant pathology involved infections, essentially respiratory and digestive. There were 13% of deaths, two out of three occurring before the 48th hour following admission: diarrhea, malaria and lung infections were the main causes of death. The laboratory tests contributed very little to therapeutic decisions, which were based more on symptomatology and its evolution, than on diagnostic certainties. Drug associations and therapeutic excess were within acceptable limits, but possibly improvable. For one-third of the diseases, simple care at home was possible, yet only performed in 50% of cases. CONCLUSION This study points out some deficiencies in management of hospitalized children and suggests improvements without more cost: reorganization of the laboratory, emergency therapeutic protocols, and activities in the villages.
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Farnoux C, Camard O, Pinquier D, Hurtaud-Roux MF, Sebag G, Schlegel N, Beaufils F. Recombinant tissue-type plasminogen activator therapy of thrombosis in 16 neonates. J Pediatr 1998; 133:137-40. [PMID: 9672527 DOI: 10.1016/s0022-3476(98)70193-3] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We report 16 cases of neonatal vascular thrombosis treated with the same protocol for recombinant tissue-type plasminogen activator infusion. Flow restoration was complete in seven patients, partial in seven, and absent in two. Safety was satisfactory provided contraindications were respected.
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Lamari M, Mastain J, Germain S, Bedu A, Aujard Y, Beaufils F, Rcbibo D, Rohrlich P. O19-3 Transfusion de concentré globulaire dédié chez le nouveau-né: expérience sur une durée de 3 ans chez 185 patients. Transfus Clin Biol 1998. [DOI: 10.1016/s1246-7820(98)80310-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Thébaud B, Azancot A, de Lagausie P, Vuillard E, Ferkadji L, Benali K, Beaufils F. Congenital diaphragmatic hernia: antenatal prognostic factors. Does cardiac ventricular disproportion in utero predict outcome and pulmonary hypoplasia? Intensive Care Med 1997; 23:10062-9. [PMID: 9407242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
UNLABELLED Despite regular progress in neonatal intensive care, congenital diaphragmatic hernia (CDH) diagnosed antenatally is still associated with up to 80% mortality. It is impossible to predict which fetus with CDH will survive or not. OBJECTIVE To identify reliable antenatal predictors of outcome and of pulmonary hypoplasia (PH) in fetuses with CDH. DESIGN Retrospective study. SETTING Paediatric intensive care unit of a university children's hospital. PATIENTS AND METHODS Antenatal parameters and presence of left ventricular hypoplasia in utero were compared retrospectively to outcome and to presence of PH in 32 consecutive newborn infants with antenatally diagnosed CDH. Antenatal parameters included: gestational age at diagnosis, herniated organs, associated malformations and presence of polyhydramnios. Size of the cardiac ventricles, the aorta (Ao) and the pulmonary artery (PA) were obtained by fetal echocardiography, from which we calculated a cardioventricular index (left ventricle/right ventricle, LV/RV) and a cardiovascular index (Ao/PA). Delivery was planned in order to provide ventilatory and hemodynamic management. In case of death, PH was assessed according to the following criteria: the lung weight/body weight index and the radial alveolar count. For statistical comparisons, patients were separated into two groups: the hypoplasia group (H) and the non-hypoplasia group (NH). RESULTS Thirty-two pregnancies were delivered. Twenty-six newborns died (81%), 6 survived (19%). When comparing non-survivors to survivors, predictors of poor outcome were: mean gestational age at diagnosis (23 vs 28 weeks, p = 0.002), intrathoracic stomach (20 vs 1 s, p = 0.01) and associated malformations (6 vs 0). Cardiac ventricular disproportion, expressed by the LV/RV ratio, appeared to correlate well with a poor outcome (0.63 in non-survivors vs 0.93 in survivors, p = 0.03) and with PH (0.63 in the H group vs 0.95 in the NH group, p = 0.03). CONCLUSIONS Our study confirmed the factors for a poor prognosis associated with CDH previously described in the literature, but none with a consistent demonstration of accuracy. LV hypoplasia may be a more accurate predictor of outcome and of PH but it has to be assessed by prospective studies with larger samples. Further basic science and Doppler-flow studies may be helpful to understand the natural history and pathophysiology of LV hypoplasia in CDH.
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Thébaud B, Azancot A, de Lagausie P, Vuillard E, Ferkadji L, Benali K, Beaufils F. Congenital diaphragmatic hernia: antenatal prognostic factors. Intensive Care Med 1997; 23:1062-9. [DOI: 10.1007/s001340050457] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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71
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Beaufils F. [The teaching of pediatric subspecialties]. ANALES ESPANOLES DE PEDIATRIA 1997; Spec No 1:10-2. [PMID: 9382245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Abstract
The adult (acute) respiratory distress syndrome is a significant cause of morbidity in children. The mortality rates remain elevated, greater than 50%, and even greater than 80% in patients with underlying malignancies. The therapeutic interventions remain mainly supportive. Strategies of conventional mechanical ventilation are directed toward the use of high positive end-expiratory pressures, low positive inspiratory pressure, and permissive hypercapnia. High-frequency oscillatory ventilation and tracheal insufflation are not yet used extensively, although they should contribute to less aggressive ventilation. Surfactant replacement, nitric oxide inhalation, and partial liquid ventilation seem to be promising technologies, but controlled clinical studies are necessary before their wide-spread use. Extracorporeal membrane oxygenation remains the alternative technology in case of failure of conventional support.
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Germain JF, Farnoux C, Pinquier D, Cortez A, Hartmann JF, Sibony O, de Lagausie P, Beaufils F. Can blood gas values predict pulmonary hypoplasia in antenatally diagnosed congenital diaphragmatic hernia? J Pediatr Surg 1996; 31:1634-9. [PMID: 8986975 DOI: 10.1016/s0022-3468(96)90036-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The prognosis of antenatally diagnosed congenital diaphragmatic hernias (CDH) is clearly related to the degree of pulmonary hypoplasia (PH). After birth, controversies remain regarding the implementation of various therapies, especially the use of extracorporeal membrane oxygenation (ECMO). In the literature, the persistence of a Pao2 below 100 mm Hg and of Paco2 above 40 mm Hg despite optimal conventional therapy indicates poor prognosis. Therefore, since 1992, published and personal experiences led the authors to exclude CDH patients from ECMO when conventional therapy (including high-frequency oscillatory ventilation and nitric oxide) did not obtain Pao2 of above 80 mm Hg and Paco2 of below 60 mm Hg. The aim of this retrospective study is to determine whether blood gas results correlate with postmortem findings. Between July 1990 and July 1994, 32 cases of CDH were monitored antenatally and managed postnatally at the authors' institution. Six patients survived; 26 died, including one immediately at birth. Thirteen were treated by ECMO. Seventeen had a best Pao2 of above 80 mm Hg, including the six survivors. Fourteen did not reach this level, and none of them survived. Twenty-three infants underwent postmortem examination. PH was assessed using two criteria: (1) lung weight to body weight ratio (LW/BW) and (2) radial alveolar count (RAC). Two patients did not have hypoplasia (LW/BW > 0.018). Twenty-one patients had PH; 12 of them had an LW/BW ratio of less than .009; for 9, the LW/BW ratio was between .009 and .018, and the RAC (< 3.1) confirmed PH. All infants with a best Pao2 of less than 80 mm Hg had PH. Patients with a best Pao2 of greater than 80 mm Hg included two infants who died from complications without PH, eight infants with demonstrated PH, and the six survivors. In conclusion. (1) No infant with nonhypoplastic lungs has been deprived of ECMO by the authors' criteria. (2) Adequate values of blood gases may not eliminate PH. Therefore, this probably justifies starting ECMO when conventional therapy fails. (3) Conversely, permanent poor values of Pao2 allowed the prediction of PH in all cases. Such patients probably can be excluded from ECMO treatment.
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Beaufils F, Vitoux-Brot C. [Acute dehydration in infants. Physiopathology, diagnosis, development, treatment]. LA REVUE DU PRATICIEN 1996; 46:1995-2000. [PMID: 8978207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Farnoux C, Germain JF, Pinquier D, Lebourgeois M, Grossi Y, Beaufils F. [Subacute extrinsic allergic alveolitis with lesion edema]. Arch Pediatr 1996; 3:988-92. [PMID: 8952793 DOI: 10.1016/0929-693x(96)81720-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Extrinsic allergic alveolitis may have a chronic, subacute or acute course. Its fulminant form with interstitial edema is unusual. CASE REPORT An 11-year-old girl was referred to our intensive care unit because she suffered from high fever. Chest X-rays showed bilateral alveolitis. History revealed home exposure to several birds for many years, and episodes of dyspnea and fever for a few months. Diagnosis of extrinsic allergic alveolitis was confirmed by strongly positive results of precipitins to avian antigens. In addition, a paramyxovirus influenzae was recovered from broncho-alveolar lavage. Treatment, including high dose steroids, hydroxychloroquine, and suppression of antigenic exposure allowed weaning from mechanical ventilation after 50 days. Severe pulmonary restriction was disclosed by lung function testing following weaning and slow improvement occurred 5 months later, despite persistent interstitial lesions on chest X-rays. CONCLUSION Extrinsic allergic alveolitis may mimic an acute respiratory distress syndrome. Documenting bird exposure in such a case helps to achieve appropriate diagnosis which requires early administration of steroids in order to improve vital and functional prognosis.
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