[Epidemio-clinical features of genital tuberculosis among Tunisian women: a series of 47 cases]. / Caractéristiques épidémio-cliniques de la tuberculose génitale chez la femme tunisienne: une série de 47 cas.

This study aimed to identify the epidemio-clinic, diagnostic, therapeutic and evolutionary features of genital tuberculosis (GT) among Tunisian women. We conducted a retrospective, descriptive study in the Department of Infectious Diseases at the La Rabta Hospital, Tunisia, over a period of 15 and a half years (January 2000 - June 2014). All patients hospitalized for genital TB were included in the study. The study focused on 47 cases. The average age of patients was 42.2 years. Eighteen women were from rural areas. Tuberculous contact was found in five cases. In all cases, the onset was insidious. Twenty-three patients showed one or several signs of TB infection. Tuberculin intradermal reaction (IDR) test was performed in 35 women (74.8%), it was positive in 26 cases (74%). Thirty-nine patients (83%) had undergone radiological examination using abdomino-pelvis ultrasound and/or CT scan. Diagnostic coelioscopy was performed in 37 cases (75.5%). Anatomopathological examination helped to confirm the diagnosis of GT in 42 cases (89.3%), showing epithelioid and giant-cell granuloma. We identified 21 cases of isolated GT, the remaining 26 cases had peritoneal involvement. All patients received specific antibiotic therapy combining isoniazid, rifampicin, pyrazinamide and ethamubutol with an average treatment duration of 12 months. No patient received corticosteroids or secondary surgery. Patients' outcome was favorable in 39 cases, 8 patients were lost to follow-up. Genital tuberculosis is rare, representing only 0.5% of extra-pulmonary tuberculosis, but it accounts for a high prevalence of clinical polymorphism. Diagnostic confirmation is difficult and it is based on bacteriological and/or histological examinations. Diagnosis should be suspected in patients with chronic abdominopelvic symptoms, in women with infertility associated with suggestive epidemioclinical manifestations.

The diagnosis of tuberculosis in dialysis patients.

The incidence of tuberculosis (TB) is high in patients undergoing chronic dialysis than it is in the general population. The diagnosis of TB is often difficult and extrapulmonary involvement is predominant. This study investigates the spectrum of clinical presentations and outcome in dialysis patients during a nine-year period. TB was diagnosed in 41 patients. Anti-TB drugs, adverse effects of therapy, and outcome were noted. Thirty-eight patients (92.6%) were on hemodialysis and three were on peritoneal dialysis (7.3%). The mean age at diagnosis was 50.8 years and the male/female ratio was 1.16. Four patients had a history of pulmonary TB. Extrapulmonary involvement was observed in 32 (78 %) patients. The bacteriological confirmation was made in 41.46% and histological confirmation was made in 26.83%, and in the rest, the diagnosis was retained on the criterion presumption. Nineteen patients (46.34%) developed adverse effects of antitubercular drugs. Eight patients (19.51%) died during the study from TB or adverse effects of treatment. Low urea reduction ratio and female sex were associated with poor prognosis in our study. The clinical manifestations of TB in patients on dialysis are quite nonspecific, making timely diagnosis difficult, and delaying the initiation of curative treatment, which is a major determinant of the outcome.

Paradoxical reaction associated with cervical lymph node tuberculosis: predictive factors and therapeutic management.

OBJECTIVES: The aims of this study were to determine predictive factors of paradoxical reaction in patients with cervical lymph node tuberculosis (TB) and to discuss the therapeutic management of this condition. MATERIALS AND METHODS: A retrospective study was performed of 501 patients managed for cervical lymph node TB over a period of 12 years (from January 2000 to December 2011). Statistical data were analyzed using IBM SPSS Statistics version 20.0. RESULTS: Paradoxical reaction occurred in 67 patients (13.4%), with a median delay to onset after starting TB treatment of 7 months. Lymph node size ≥3cm and associated extra-lymph node TB were independently associated with paradoxical reaction. Treatment consisted of surgical excision (71.6%), restarting quadruple therapy (10.4%), reintroduction of ethambutol (23.8%), and addition of ciprofloxacin (20.8%); steroids were given in two cases . All patients recovered after an average treatment duration of 14.91±7.03 months. CONCLUSION: The occurrence of paradoxical reaction in cervical lymph node TB seems to be predicted by associated extra-lymph node TB and a swelling size ≥3cm. The treatment of paradoxical reaction remains unclear and more randomized trials are necessary to improve its management.

Structural insight into a novel human CCR5-V130I variant associated with resistance to HIV-1 infection.

We report the identification of a novel CC chemokine receptor 5 (CCR5) variant that seems associated with resistance to HIV-1 infection. The V130I mutation of the CCR5 receptor is located in the intracellular loop ICL2 known as DRY box and described in the literature as a nonsynonymous mutation present in nonhuman primates group. Extensive molecular modeling and dynamics simulations were performed to elucidate the mechanism by which the V130I mutation may induce conformational change of the CCR5 folding protein and prevent the interaction with the ß-arrestin protein. Our study provides new mechanistic insight into how a specific mutation in the regulatory domain of CCR5 might alter the structural folding of the DRY box and the possible ICL2 loop binding with the ß-arrestin protein, as described in our previous computational study. The results from our large-scale simulations complement recent experimental results and clinical features and offer useful insights into the mechanism behind CCR5 protein folding and signal transduction. In order for HIV, the entry of the virus to the cells must fuse with the CCR5 receptor that sits on the surface of T-helper immune cells. The described V130I mutation in the gene encoding the CCR5 protein may results in a defective CCR5-Arrestin binding complex that blocks entry of the virus.

[Upper urinary tract infections in adults: about 261 episodes]. / Infections urinaires hautes de l'adulte: à propos de 261 épisodes.

BACKGROUND: Upper urinary tract infections are frequent. Escherichia coli is the main pathogen identified from community acquired infections. AIM: We aim to study epidemiologic, clinical and bacterial features of this infection. METHODS: We identified 261 episodes that occurred in 241 patients. They were 213 females and 48 males aged of 48.75 years. Enterobacteriaceae were the main pathogens isolated in 93.5%: E. coli in 73.3% and Klebsiella pneumoniae in 15.3%. E. coli sensitivity was of 30% for amoxicillin, 98% for cefotaxim, 96% for gentamicin, 90% for ciprofloxacin and 56% for co-trimoxazole. Anterior antibiotic use was associated with low E. coli sensitivity mainly with fluoroquinolones (96 vs 77%) and co-trimoxazole (62 vs 43%). This enhances the role of antibiotic pressure on the resistance emergence. CONCLUSION: the reasonable use of antibiotics is necessary to limit resistance extent.

[Hereditary complement C5 deficiency: study of 3 Tunisian adult cases and literature review]. / Deficit héréditaire en protéine C5 du complément: etude de 3 cas tunisiens de l'adulte et revue de la littérature.

BACKGROUND: The complement system is one of the main effectors of both innate and adaptive immunity. Hereditary complement deficiency, mainly those of the terminal pathway (C5-C9), is at increased risk for septic meningitides particularly meningococcal ones. AIM: to assess clinical and biochemical features of 3 Tunisian adults with C5 hereditary complement deficiency (C5D), with a familial study performed for two of them. METHODS: Functional activity of the classical and the alternative pathway of complement (CH50 and AP50 respectively) were measured according to standards haemolytic procedures. Serum concentration of complement components were determined by nephelemetry and ELISA. C5D was diagnosed when CH50, AP50 and C5 antigenic level were highly decreased. RESULTS: Our patients were 2 men and one woman. All these patients presented clinical symptoms of septic meningitides. Meningococcal orign was confirmed in one case. C5 level varies between 0 and 0.4%. Levels of other complement components: Clq, C3, C4, properdine, C6, C8 and C9 were normal. Antigenic C7 level was 50% in the female patient. Familial study revealed no similar hereditary complement deficiency in relatives. CONCLUSION: Only 27 cases with C5D were reported in the literature. The description of 3 cases in our series demonstrates that: * C5D is not rare in Tunisia, ** C5D is clinically commonly complicated by meningitides with unconstant severity, *** C5D is biologically caracterised by a variable level of the plasmatic C5 component.

Genetic identification of intestinal microsporidia species in immunocompromised patients in Tunisia.

Stool samples from 86 immunocompromised patients (51 human immunodeficiency virus (HIV)-infected patients and 35 patients with haematologic malignancies) were systematically screened for intestinal microspordiosis by microscopic examination and polymerase chain reaction (PCR) using universal primer V1/PMP2. Nine samples (10.5%) showed amplification with the predictive size of fragment (6 from HIV-infected patients and 3 from patients with myeloma). Only 5 out of them (all HIV-infected patients) were revealed positive by microscopy. By means of amplicons fragment size, species-specific primers (V1/EB450, V1/IS500) and sequencing, 3 microsporidia species were for the first time identified in Tunisia: Enterocytozoon bieneusi (3 isolates), Encephelitozoon intestinalis (2 isolates), and Encephalitozoon hellem (1 isolate). Systematic use of such sensitive and discriminative molecular tools will contribute to determining the true prevalence of microsporidiosis in Tunisia and to better management of infected immunocompromised subjects.

Identification of cryptosporidium species infecting humans in Tunisia.

Prevalence and species distribution of Cryptosporidium spp. were determined among 633 immunocompetent children less than five years of age and 75 patients hospitalized for immunodeficiency who lived in northern Tunisia. Microscopy was used for initial screening to detect positive samples and a nested polymerase chain reaction and restriction fragment length polymorphism analysis was used to determine the species. Cryptosporidium spp. was identified in 2.7% of cases (19 stool samples), and there was a significant difference between samples collected from immunocompromised patients and those collected from healthy children (10.7% versus 1.7%). Prevalence was also significantly higher in diarrheal specimens than in formed specimens (6.3% versus 1.6%). Cryptosporidium hominis and C. parvum were responsible for most Cryptosporidium spp. infections (78.9%). Cryptosporidium hominis was more prevalent in children from urban areas than in those from rural areas, and C. parvum was found with similar prevalence rates in the two populations. Cryptosporidium meleagridis was identified in four children on farms.

Hereditary complement deficiency and lupus: report of four Tunisian cases.

The aim of the study was to assess the clinical and immunological profile of lupus erythematosus (LE) patients with inherited complement deficiency (ICD). A laboratory-based study was conducted in which all LE patients with hypocomplementemia were included. ICD was assessed by hemolytic and antigenic assays. Type I C2 deficiency was assessed by polymerase chain reaction (PCR). ICD was diagnosed in four cases. In three systemic LE patients, ICD were: homozygous C2 deficiency in the first case, heterozygous C2 deficiency in the second, and homozygous C1q deficiency in the third case. In a discoid LE patient, a combined homozygous C2 and C6 deficiency was diagnosed. Almost all of our patients presented the classical clinical and immunological features of LE associated with ICD. Severe lupus with renal involvement and recurrent infections was present in half of the patients suggesting that these patients are prone to a serious management.

Tuberculous meningitis in adults: MRI contribution to the diagnosis in 29 patients.

OBJECTIVES: Tuberculous meningitis (TBM) is a life-threatening disease and is difficult to diagnose. We aim to promote the role of magnetic resonance imaging (MRI) in TBM diagnosis and survey. DESIGN AND METHODS: This was a retrospective study undertaken between 1996 and 2003 in which we reviewed all cases of TBM that had undergone cerebral computed tomography (CT) and MRI performed with and without contrast. RESULTS: We reviewed 29 patients; all had had subacute lymphocytic meningitis. Diagnosis was definite in only 11 cases and presumptive in 18 cases. MRI was performed showing one or more abnormalities in 26 cases. The use of MRI allowed the detection of CNS lesions in both brain and spine. CONCLUSION: Cerebrospinal MRI performed when TBM is suspected aids in its diagnosis and is also a useful means of monitoring the course of the disease under treatment.

[Pulmonary aspergillosis in a child with chronic granulomatous disease]. / Aspergillose pulmonaire invasive chez un enfant porteur d'une granulomatose septique chronique.

The chronic granulomatous disease is characterised by the occurence of multiple bacterial and fungal infections since the early childhood. This susceptibility to infections must be prevented by a primary prophlylaxis against the opportunistic germs like pneumocystis and aspergillus. Our case is about a twelve-year-old boy who had a prophylaxis since his fourth month of life. At 10 years he presented a pleuro-pneumonia refractory to a large spectrum antibiotherapy. The aspergillar etiology was established on clinical, radiological and serological arguments. An amphotericine B treatment allowed a good clinical and radiological outcome of this pleuro-pulmonary affection. However, a dorsal spondylodiscitis complicated the course of the disease. A secondary vertebral aspergillosis or a Pott's disease were suspected. The vertebral bipsy was'nt conclusive. The association of antituberculous and antifungal agents with adjuvant molecules (IFN, granulotic transfusions and GM-CSF) permitted a good clinical outcome and the stabilisation of the radiological lesions.