Murine typhus in Tunisia: a neglected cause of fever as a single symptom.

OBJECTIVES: We had for aim to describe the epidemiologic and clinic characteristics of murine typhus in a series of 43 serologically confirmed cases, in our region. PATIENTS AND METHODS: Serologic screening for IgG and IgM against Rickettsia typhi was performed in 1024 patients during three years (2006-2008). The characteristics of patients with a positive serology were examined retrospectively. One hundred and seventy sera obtained from blood donors were tested to detect IgG against R. typhi to determine the seroprevalence of the infection. RESULTS: There was evidence of recent R. typhi infection in 43 patients (4.2%) during the study period, and 3.7% of blood donors had IgG against R. typhi. The mean age of patients was 43.1 years and the sex-ratio was 1.04. Among the patients, 58.1% were from rural areas. No patient reported any exposure to rats or rat-fleas. There were more cases during the summer and fall. The most frequent complaint was fever as a single symptom (67.5%). A cutaneous rash was reported in 44.1% and headache in 60.5% of patients. Among the patients, 44.1% presented with thrombopenia and 47.2% with elevated liver enzymes. CONCLUSION: Murine typhus seems to be frequent in Tunisia. This infection could be a threat for travellers. Serology should be performed systematically in patients with fever as a single symptom since its clinical presentation is non-specific.

Rubella associated with hemophagocytic syndrome. First report in a male and review of the literature.

A 22-year-old man was admitted to our hospital because of fever, skin rash and epistaxis. Physical examination revealed fever (39.5°C), generalized purpura, lymphadenopathy and splenomegaly. Blood tests showed pancytopenia. Bone marrow aspiration and biopsy showed hemophagocytosis with no evidence of malignant cells. Anti rubella IgM antibody were positive and the IgG titers increased from 16 to 50 UI/mL in 3 days. Therefore, he was diagnosed to have rubella-associated hemophagocytic syndrome. We report herein the first case in a man and the sixth case of rubella-associated hemophagocytic syndrome in the literature by search in Pub Med till March 2012.

[Diagnosis of peripheral tuberculous lymphadenitis in Tunisia]. / Diagnostic de la tuberculose ganglionnaire périphérique en Tunisie.

OBJECTIVE: The aim of the study was to evaluate the contribution of microbiology, cytology, and anatomopathology in 50 cases of peripheral tuberculous lymphadenitis. METHODOLOGY: Our patients underwent bacteriological tests and cytology and/or histopathology for lymphadenitis. RESULTS: Ziehl-Neelsen stains and cultures were positive in only 29.7% and 10.8% of cases respectively. The diagnosis was confirmed by cytology in 31.3% of cases (10/32) and by histology in 58.6% of cases (27/46). Granulomas were observed in 46.8% (15/32) of needle aspirates and 76% (35/46) of surgical biopsies. CONCLUSION: Our study reveals a weak contribution of conventional microbiological techniques. Cytology remains the procedure of choice in endemic countries. Excisional biopsy may be performed in case of doubt.

[Multifocal Langerhans cell histiocytosis of bone: late revelation in a 76-year-old woman]. / Histiocytose langerhansienne osseuse multifocale: révélation tardive chez une femme de 76 ans.

Langerhans cell histiocytosis or histiocytosis X has a variable course from a self-limited eosinophilic granuloma to an aggressive disseminated disease. It mainly affects children. We report a 76-year-old woman with multifocal bone histiocytosis X, involving the rachis, an iliac bone and the skull. The diagnosis has been established by histological exam. Outcome was favourable after chemotherapy.