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Les virus sont une des causes fréquentes d’infection respiratoire chez les enfants. Cette étude a pour but de comparer la performance d’un test antigénique rapide par rapport à la méthode de Polymerase Chain Reaction (PCR) pour la détection de 3 virus (le virus respiratoire syncytial [RSV], l’adénovirus [ADV] et l’influenza A/B [INF A/B]). Nous rapportons les résultats d’une étude prospective réalisée dans le cadre de la surveillance des infections respiratoires aiguës (IRA) de Sciensano (Institut de Santé Publique en Belgique). Entre octobre 2018 et avril 2019, 140 échantillons de cellules naso-pharyngées prélevés chez 135 enfants hospitalisés pour IRA au CHU Dinant -Godinne (Belgique). Le test antigénique rapide est revenu positif pour 71/140 (50.7%) échantillons tandis que la PCR est revenu positive pour au moins un virus pour 123/140 (87.8%) échantillons. Nous avons déterminé la sensibilité (Se), spécificité (Sp), valeur prédictive positive (VPP) et valeur prédictive négative (VPN) du test rapide par rapport à la RT-qPCR (PCR) utilisée comme gold standard. Les résultats pour le test antigénique rapide pour le RSV sont respectivement de Se 80.3% ; Sp 100%, VPP 100% et VPN 85% ; pour le ADV : Se 6.25%, Sp 99%, VPP 66.7% et VPN 78.1% et pour INF: Se 87.5%, Sp 98.4%, VPP 87.5% et VPN 98.4%.

Hepatic capillariasis is a neglected, but serious, hepatic disease with a worldwide distribution caused by the nematode Calodium hepaticum.1–4 The nematode has a monoxenous life cycle and can infect any mammalian liver but mainly affects rodents, while humans are an accidental host.1,3,4 Infection occurs after ingestion of embryonated eggs from contaminated soil. The larvae hatch in the intestine, migrate, mature, and mate in the liver parenchyma, with hundreds unembryonated eggs laid.1,5 The eggs remain viable in the liver and are released into the environment after death of the host.3,4 In the soil, the eggs reach the infective stage.3,5 Poor sanitation and living conditions predispose to infection.1,5 There is a higher incidence in children attributable to higher soil-to-hand-to-mouth contact. Pica is an additional risk, particularly when presenting as geophagia.1 A 3-year-old Afghan girl born in Belgium and living in an asylum seeker center was referred for persistent high fever and abdominal pain. A history of pica was present. Pallor, weakness, and hepatomegaly were observed on clinical examination. Blood tests revealed elevated C-reactive protein (151 mg/L), ALT (360 IU/L), AST (207 IU/L), IgM levels (13.05 g/L), microcytic anemia (8.3 g/dL), and eosinophilia (12,750/µL). Stool cultures were negative. Abdominal ultrasound examination showed hepatosplenomegaly with ascites. FibroScan revealed minor fibrosis with a stage F1. Serology for Fasciola hepatica and Toxocara canis was positive. Liver biopsy revealed adult nematodes and eggs. The child was treated with triclabendazole (10 mg/kg/day) for 2 days then albendazole (50 mg/kg/day) and methylprednisolone (1 mg/kg/day) for 5 days. She responded well. Twenty days after treatment, she presented with a relapse. A review of the liver biopsy identified the diagnostic features of C. hepaticum (Fig. 1). This diagnosis was confirmed by PCR on the liver tissue. The positive Fasciola and Toxocara serologic tests were de

Transcriptome profiling of blood cells is an efficient tool to study the gene expression signatures of rheumatic diseases. This study aims to improve the early diagnosis of pediatric rheumatic diseases by investigating patients' blood gene expression and applying machine learning on the transcriptome data to develop predictive models. RNA sequencing was performed on whole blood collected from children with rheumatic diseases. Random Forest classification models were developed based on the transcriptome data of 48 rheumatic patients, 46 children with viral infection, and 35 controls to classify different disease groups. The performance of these classifiers was evaluated by leave-one-out cross-validation. Analyses of differentially expressed genes (DEG), gene ontology (GO), and interferon-stimulated gene (ISG) score were also conducted. Our first classifier could differentiate pediatric rheumatic patients from controls and infection cases with high area-under-the-curve (AUC) values (AUC = 0.8 ± 0.1 and 0.7 ± 0.1, respectively). Three other classifiers could distinguish chronic recurrent multifocal osteomyelitis (CRMO), juvenile idiopathic arthritis (JIA), and interferonopathies (IFN) from control and infection cases with AUC ≥ 0.8. DEG and GO analyses reveal that the pathophysiology of CRMO, IFN, and JIA involves innate immune responses including myeloid leukocyte and granulocyte activation, neutrophil activation and degranulation. IFN is specifically mediated by antibacterial and antifungal defense responses, CRMO by cellular response to cytokine, and JIA by cellular response to chemical stimulus. IFN patients particularly had the highest mean ISG score among all disease groups. Our data show that blood transcriptomics combined with machine learning is a promising diagnostic tool for pediatric rheumatic diseases and may assist physicians in making data-driven and patient-specific decisions in clinical practice.

Si l’hydronéphrose anténatale (HNA) est la malformation congénitale la plus fréquente, sa prise en charge est cependant controversée surtout en ce qui concerne le bilan à réaliser et l’intérêt d’une prophylaxie. Des études récentes remettent en doute l’indication systématique d’une cystographie à la recherche d’un reflux associé tout comme le bénéfice de l’antibioprophylaxie sur la survenue d’infection urinaire. Une approche moins agressive est discutée tenant compte essentiellement des données échographiques obtenues en postnatal. Nous proposons un algorithme de prise en charge tenant compte de ces données.

Dans cet avis scientifique, qui propose des lignes directrices aux responsables des politiques en matière de santé publique, le Conseil supérieur de la santé de Belgique émet des recommandations sur les groupes à risque dans le cadre de la vaccination contre le Covid-19 pour la population belge. Cet avis vise à proposer aux décideurs politiques des recommandations précises sur les groupes à risque, les groupes prioritaires ainsi qu'une estimation du nombre de vaccins nécessaires si un vaccin contre le Covid-19 voyait le jour.

We report the case of a 13-year-old girl with Down’s syndrome who presented with cough, fever, and a rapidly evolving respiratory failure leading to intensive care unit transfer during coronavirus disease 2019 (COVID-19) outbreak in Belgium. COVID-19-related acute respiratory distress syndrome (ARDS) is rare in teenagers and its diagnosis remains challenging as reverse transcription-polymerase chain reaction (RT-PCR)-testing sensitivity and radiological criteria still have to be defined in that population. We finally concluded to severe Mycoplasma pneumoniae infection. This case report gives the opportunity to discuss the rare occurrence of that disease, and to review the radiological findings of M. pneumoniae- and COVID-19-related pneumonia in teenagers.

BACKGROUND: Meningitis can be caused by several viruses and bacteria. Identifying the causative pathogen as quickly as possible is crucial to initiate the most optimal therapy, as acute bacterial meningitis is associated with a significant morbidity and mortality. Bacterial meningitis requires antibiotics, as opposed to enteroviral meningitis, which only requires supportive therapy. Clinical presentation is usually not sufficient to differentiate between viral and bacterial meningitis, thereby necessitating cerebrospinal fluid (CSF) analysis by PCR and/or time-consuming bacterial cultures. However, collecting CSF in children is not always feasible and a rather invasive procedure. METHODS: In 12 Belgian hospitals, we obtained acute blood samples from children with signs of meningitis (49 viral and 7 bacterial cases) (aged between 3 months and 16 years). After pathogen confirmation on CSF, the patient was asked to give a convalescent sample after recovery. 3' mRNA sequencing was performed to determine differentially expressed genes (DEGs) to create a host transcriptomic profile. RESULTS: Enteroviral meningitis cases displayed the largest upregulated fold change enrichment in type I interferon production, response and signaling pathways. Patients with bacterial meningitis showed a significant upregulation of genes related to macrophage and neutrophil activation. We found several significantly DEGs between enteroviral and bacterial meningitis. Random forest classification showed that we were able to differentiate enteroviral from bacterial meningitis with an AUC of 0.982 on held-out samples. CONCLUSIONS: Enteroviral meningitis has an innate immunity signature with type 1 interferons as key players. Our classifier, based on blood host transcriptomic profiles of different meningitis cases, is a possible strong alternative for diagnosing enteroviral meningitis

Introduction: Late onset intestinal stenosis and subocclusion after blunt abdominal trauma is a rare entity. Only a few cases have been reported in the literature. The symptoms may occur months to years after the abdominal trauma. Various mechanisms are described such as localized intestinal ischemia, small perforation of the bowel or mesenteric vascular injury. We report a case of a late onset small intestine stenosis 2 months after a blunt abdominal trauma. Case report: A 7 years old girl was involved in a high velocity car crash, she was seat-belted. Immediately after the car crash, she complained of acute abdominal pain. The CT scan showed intraperitoneal liquid of undetermined origin. A diagnosis of digestive ileus and mesenteric contusion was made. The child was transferred to the intensive care unit for observation. A week later, the symptoms had disappeared and she was discharged. A month after the car crash, she was admitted to the emergency room for chronic abdominal pain and acute vomiting. The ultrasonography and the CT scan showed ileitis and inflammatory intestinal stenosis of 15 centimeters in right iliac fossa. Laboratory tests showed no signs of inflammatory disease. After antalgic treatment, the girl was no longer painful. Two weeks later, the girl was admitted again in the pediatric department for major abdominal pain, vomiting, constipation and weight loss. The ultrasonography showed intestinal subocclusion. After failure of conservative treatment, a laparotomy was performed. Two stenotic segments of the small intestine were removed. Histopathological examination revealed ischemic necrosis of the small bowel’s segments. She completely recovered and remained asymptomatic for the 2 next months. Discussion and conclusion: Subocclusion and intestinal stenosis must be considered in differential diagnostic of chronic pain with or without vomitting after a blunt abdominal trauma. Ignorance of these late onset sequelae may induce delay of treatment. Pati

As group A Streptococcus (GAS) meningitis is seldom reported in children, emm-type distribution data are scare. We report eight cases of GAS meningitis in Belgium (2008-2013) and compare molecular characteristics of our strains with a further 55 cases previously reported with their corresponding emm-types. emm1 type was the most frequent (24%) followed by emm6 (11%), emm12 (11%) and emm3 (6%). Together these four emm-types accounted for 52% of the cases, while the rest of the cases are due to 24 different emm-types. These 28 emm-types associated with GAS meningitis belonged to 16 different emm-clusters suggesting that there is no propensity for particular emm-types or emm-cluster to cause meningitis. Theoretical coverage of the 30-valent vaccine candidate would be 77.8% (49/63 isolates) among children with GAS meningitis.

Background: Varicella universal vaccination (UV) has been implemented in many countries for several years. Nevertheless, varicella UV remains debated in Europe and few data are available on the real burden of infection. We assessed the burden of varicella in Belgium through analysis of hospitalised cases during a 1-year period. Methods: Data on children admitted to hospital with varicella were collected through a national network from November 2011 to October 2012. Inclusion criteria were either acute varicella or related complications up to 3 weeks after the rash. Results: Participation of 101 hospitals was obtained, covering 97.7% of the total paediatric beds in Belgium. 552 children were included with a median age of 2.1 years. Incidence of paediatric varicella hospitalisations reached 29.5/105 person-years, with the highest impact among those 0-4 years old (global incidence and odds of hospitalisation: 79/105 person-years and 1.6/100 varicella cases, respectively). Only 14% (79/552) of the cohort had an underlying chronic condition. 65% (357/552) of children had ≥ 1 complication justifying their admission, 49% were bacterial superinfections and 10% neurological disorders. Only a quarter of children (141/552) received acyclovir. Incidence of complicated hospitalised cases was 19/105 person-years. Paediatric intensive care unit admission and surgery were required in 4% and 3% of hospitalised cases, respectively. Mortality among Belgian paediatric population was 0.5/106 and fatality ratio 0.2% among our cohort. Conclusions: Varicella demonstrated a substantial burden of disease in Belgian children, especially among the youngest. Our thorough nationwide study, run in a country without varicella UV, offers data to support varicella UV in Belgium.

Toxic epidermal necrosis is a severe mucocutaneous disease with a high mortality rate. A third of the patients surviving the acute phase will develop pulmonary complications. The most frequent complication is bronchiolitis obliterans. Despite well-conducted treatment, in most cases, lung injury often leads to chronic respiratory failure. We describe here the case of a young patient that presented a toxic epidermal necrosis at the age of 3 years. Poor therapeutic compliance result in chronic respiratory failure and after 7 years of follow-up, pulmonary transplant remains the only long-term alternative. Close monitoring of respiratory symptoms in the course of toxic epidermal necrosis, intense treatment as soon as they appear and a long-term follow-up are essential to postpone chronic respiratory failure.