ABSTRACT
UNLABELLED: Crohn's disease occur mainly in adults. However, pediatric onset forms are not rare and have many characteristics. AIM: to study clinical, diagnostic, therapeutic and evolutive characteristics of crohn's disease in tunisian children. METHODS: Retrospective multicenter study conducted in 10 pediatric departments on a period of 10 years (2000-2008) RESULTS : 43 children were included. The sex-ratio was 1.68. The mean age at the onset of the symptoms was 11+/-2.3 years (5-16 years). The age of onset was inferior to 10 years in 25 % of the children. The delay before management was superior to 1 year in 25% of cases. The initial symptoms were dominated by diarrhea (95%). Perineal manifestations were present at diagnosis in 30% of children and extra-digestive manifestations in 53%. Ileocolonic localization was the most frequent (46%). The initial disease flare was moderate in 83% of cases. The treatment was medical in 77 % of cases, nutritional and medical in 18.5%. Maintenance therapy was instituted in 86% of cases and consisted essentially in azathioprin (62%). The mean follow-up was 3 years and 4 months. 60% of the children had at least one acute flare. During evolution, 7% of children had anoperineal surgery and 11% an intestinal resection. CONCLUSION: Crohn's disease seems rare in Tunisia. The time of diagnosis is often delayed. The management is based on immunosuppressive therapy and nutritional support.
Subject(s)
Crohn Disease , Adolescent , Child , Child, Preschool , Crohn Disease/epidemiology , Crohn Disease/etiology , Crohn Disease/therapy , Disease Progression , Female , Humans , Male , Retrospective Studies , Risk Factors , Tunisia/epidemiologyABSTRACT
OBJECTIVE: The authors had for aim to analyze pertussis epidemiology in Tunisia by studying nasopharyngeal specimens of infants hospitalized in Tunis. METHODS: Between march 2007 and march 2008, clinical nasopharyngeal samples were collected from infants with a suspected diagnosis of whooping cough, pertussoid cough, or pertussis-like syndrome, admitted at the Tunis children's hospital. The laboratory diagnostic criteria were culture isolation of Bordetella species on Bordet-Gengou medium and real-time PCR. RESULTS: Fifty-nine percent of the 74 investigated children with suspected pertussis were less than two months of age. The diagnosis of pertussis was proved positive by real-time PCR for 41%. Culture was negative in all cases. CONCLUSIONS: Whooping cough is still prevalent in Tunisia despite an important vaccination coverage. Real-time PCR is an invaluable tool for the rapid diagnosis of pertussis, however culture must also be associated.
Subject(s)
Disease Outbreaks , Whooping Cough/epidemiology , Anti-Bacterial Agents/therapeutic use , Bacteriological Techniques , Bordetella pertussis/genetics , Bordetella pertussis/growth & development , Bordetella pertussis/isolation & purification , Computer Systems , DNA, Bacterial/analysis , Female , Humans , Infant , Infant, Newborn , Male , Nasopharynx/microbiology , Pertussis Vaccine , Polymerase Chain Reaction , Tunisia/epidemiology , Vaccination/statistics & numerical data , Whooping Cough/drug therapy , Whooping Cough/prevention & controlABSTRACT
Listeria monocytogenesis a Gram positive facultative intracellular bacterium that can be responsible for severe infections, affecting essentially pregnant women, immunocompromised patients at the early and later stages of life. In Tunisia, invasive L. monocytogenes infections are thought to be exceptional and limited data are available about listeriosis. We reported seven cases (five newborn children and two infants) of human listeriosis that occurred in Tunis from 2000 to 2008. The newborn children were hospitalized for suspicion of maternofoetal infections. The two infants were hospitalized for fever associated with digestive signs in one case and neurological signs in the other. L. monocytogenes-was isolated from culture of cerebrospinal fluid in four cases, peripheral samples in two cases and from blood culture in one case. Isolates identification was based on conventional methods. Antimicrobial susceptibility was realized according to the recommendation of the "Comité de l'antibiogramme de la Société française de microbiologie". All L. monocytogenes isolates were sensitive to amoxicillin and aminoside but resistant to 3rd generation cephalosporins. Investigations of the immune system were realized for the two infants including phenotypic analysis of peripheral blood cells by flow cytometry, lymphocyte proliferation assays, phagocytic cell functions and measurement of immunoglobulins as well as complement. All these explorations were normal for both infants. The outcome was fatal in only one case (a newborn child), and all the other patients recovered after adapted antibiotic treatment. In conclusion, our study shows that listeriosis is not exceptional in Tunis. Thus, it is necessary to know how to evoke this diagnosis, at any age, in order to establish an early and adapted antibiotic treatment and to avoid fatal outcome.
Subject(s)
Listeriosis/epidemiology , Antibodies, Bacterial/analysis , Bacteremia/epidemiology , Bacteremia/microbiology , Carrier State/microbiology , Drug Resistance, Microbial , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical/statistics & numerical data , Listeria monocytogenes/drug effects , Listeria monocytogenes/immunology , Listeria monocytogenes/isolation & purification , Listeriosis/cerebrospinal fluid , Listeriosis/drug therapy , Listeriosis/immunology , Listeriosis/microbiology , Lymphocyte Count , Male , Meningitis, Listeria/cerebrospinal fluid , Meningitis, Listeria/epidemiology , Pregnancy , Pregnancy Complications, Infectious , Shock, Septic/etiology , Tunisia/epidemiologyABSTRACT
BACKGROUND: Rotaviruses are the most frequent agents associated with diarrhoea in children worldwide. Analysis of mobility of the 11 segments of genomic RNA by polyacrylamide gel electrophoresis (PAGE) yields a pattern which is characteristic for a particular rotavirus isolate. The group A rotaviruses can be further characterized by analysis of VP7 and VP4 genes specificities, responsible for rotavirus classification into G and P genotypes, respectively. The aim of the present study was to detect a relationship between electropherotype pattern and molecular characteristics of the rotavirus strains. MATERIAL AND METHODS: Were analyzed 278 rotavirus-positive specimens by PAGE and G/P-genotyped by multiplex semi-nested RT-PCR. Pearson's correlation tests were used for statistical analysis. RESULTS: Twelve different electropherotypes were visualized, eight with a long profile (186 cases) and four with a short one (87 cases). Concerning VP7 types, G2 viral strains were found to be predominant and were detected in 91 specimens (32.7%). Strains with G1, G3, G4, G8 and G9 specificities were detected in 62 (22.3%), 82 (29.5%), 13 (4.7%), two (0.7%) and seven cases (2.5%), respectively. The results of VP4 genotyping showed a predominance of P[8] genotype which comprised half of the strains identified (139 cases, 50%). VP4 P[4], P[6] and P[11] were found in 83 (29.9%), 31 (11.1%) and 11 (4.0%) specimens, respectively. A high rate of mixed strains was also found (1.8% mixed electropherotypes, 7.6% G-mixed and 5% P-mixed strains). Electropherotype pattern of rotavirus strains was significantly correlated with VP7 genotype (p=0.018) and with VP4 genotype specificities (p<0.001).
Subject(s)
Antigens, Viral/analysis , Capsid Proteins/analysis , Diarrhea/virology , RNA, Viral/analysis , Rotavirus Infections/virology , Rotavirus/isolation & purification , Antigens, Viral/genetics , Capsid Proteins/genetics , Child , Diarrhea/epidemiology , Electrophoresis, Polyacrylamide Gel , Feces/virology , Genotype , Humans , RNA, Viral/genetics , Rotavirus/chemistry , Rotavirus/classification , Rotavirus/genetics , Rotavirus Infections/epidemiology , Silver Staining , Tunisia/epidemiologyABSTRACT
BACKGROUND: Rotaviruses are the most frequent agents associated with diarrhoea in children worldwide. Analysis of mobility of the 11 segments of genomic RNA by polyacrylamide gel electrophoresis (PAGE) yields a pattern which is characteristic for a particular rotavirus isolate. The group A rotaviruses can be further characterized by analysis of VP7 and VP4 genes specificities, responsible for rotavirus classification into G and P genotypes, respectively. The aim of the present study was to determine the evolution of group A Rotavirus strains circulating in Tunisia over a 3-year period (2005-2007). MATERIAL AND METHODS: A total of 1503 stool samples collected from children less than five years old, consulting or hospitalised in Tunisia for diarrhoea between 2005 and 2007, were screened for the presence of group A Rotaviruses. Rotavirus-positive specimens were further analyzed by PAGE and G/P-genotyped by multiplex semi-nested RT-PCR. RESULTS: Rotaviruses were detected in 323 stool samples over 1503 (21 %). Long electropherotypes predominated in Tunisia during the whole period of study (N=158 vs N=82 short electropherotypes). VP7 genotyping showed the cocirculation of five different genotypes: G1, G2, G3, G4 and G9. VP4 typing detected four different P-genotypes: P[8], P[4], P[6] and P[11]. Rotavirus strains with G3P[8] specificity were predominating in Tunisia in 2005 and 2006, replaced by G2P[4] strains in 2007.
Subject(s)
Rotavirus/classification , Rotavirus/genetics , Antigens, Viral/genetics , Capsid Proteins/genetics , Child, Preschool , Diarrhea/virology , Feces/virology , Genotype , Humans , Infant , Infant, Newborn , RNA, Viral/analysis , TunisiaABSTRACT
We have collected cases of iatrogenic meningitis managed in the Children's Hospital of Tunis, between January 1998 and December 2006. Clinical information about each patient were collected, all bacterial samples were investigated in the microbiology laboratory of the hospital. Bacterial isolates were identified according to conventional criteria. In the interval under study, we recorded three cases of iatrogenic meningitis after lumbar puncture. Two cases occurred in newborn admitted for suspicion of neonatal infection and one in a 2-month-old infant admitted for exploration of hyperpyretic convulsion. In all patients, the initial cerebrospinal fluid was normal. All patients developed symptoms of acute meningitis within 72 hours after lumbar puncture; the second cerebrospinal fluid was, then, typical for purulent meningitis. The causal agents isolated in the three cases were Klebsiella pneumoniae, Enterobacter cloacae, and Serratia marcescens, all resistant to beta-lactams by extended spectrum beta-lactamase production. The use of quinolones was required in all cases. Different complications were recorded: hydrocephalus and brain abscess in one case, respiratory and hemodynamic failure managed in the intensive care unit in the second, and brain hygroma in the third case. This study shows high morbidity of iatrogenic meningitis. Simple aseptic precautions undertaken before the procedure of lumbar puncture can prevent such cases. The urgent need for increasing the awareness among medical personnel in hospitals of developing countries cannot be overemphasized.
Subject(s)
Enterobacter cloacae/isolation & purification , Enterobacteriaceae Infections/etiology , Infant, Premature, Diseases/etiology , Klebsiella Infections/etiology , Klebsiella pneumoniae/isolation & purification , Meningitis, Bacterial/etiology , Serratia Infections/etiology , Serratia marcescens/isolation & purification , Spinal Puncture/adverse effects , Brain Abscess/etiology , Brain Damage, Chronic/etiology , Ciprofloxacin/therapeutic use , Drug Therapy, Combination , Enterobacter cloacae/drug effects , Enterobacteriaceae Infections/drug therapy , Female , Fosfomycin/therapeutic use , Humans , Hydrocephalus/etiology , Iatrogenic Disease , Imipenem/therapeutic use , Infant , Infant, Newborn , Infant, Premature , Infant, Premature, Diseases/diagnosis , Infant, Premature, Diseases/drug therapy , Klebsiella Infections/drug therapy , Klebsiella pneumoniae/drug effects , Male , Meningitis, Bacterial/drug therapy , Meningitis, Bacterial/microbiology , Muscle Hypotonia/diagnosis , Seizures/diagnosis , Serratia Infections/drug therapy , Serratia marcescens/drug effects , Subdural Effusion/etiology , Tunisia , beta-Lactam ResistanceABSTRACT
We conducted a retrospective study of meningococcal invasive diseases (MID) contracted in children in Tunis between January 1997 and January 2006. The purpose of this study is to specify the clinical, epidemiological, therapeutic and evolutionary features of these infections and to determine antimicrobial susceptibility and the antigenic formula of N. meningitidis isolates. During the study period, we have collected 79 cases of MID arising in children aged 3 days to 11 years. The majority of children's were less than of 4 years (57.3%). We note a frequency of the MID in winter and in spring. The most frequent clinical shape was meningitis (53%). Twenty one patients (26.6%) had a fulminant meningococcal disease. In our series, the rate of lethality was equal to 17.7%. Among the 46 meningococcal isolates, the most frequent serogroup was the B (73%) followed by C and A. A high heterogeneousness of the antigenic formulae was observed The most frequent phenotype was NT: NST for the group B isolates and 4:P1.13 for the group C ones. N meningitidis with reduced susceptibility to penicillin and to amoxicillin account for 54% and 10% of all isolates respectively. The cefotaxim and the rifampin were uniformly active.
Subject(s)
Meningitis, Meningococcal/microbiology , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Retrospective Studies , TunisiaABSTRACT
BACKGROUND: Inhalation of laryngotracheobronchial foreign body in children is a serious accident that may compromise the prognosis of the child and the respiratory function in the long term. AIM: identify the predictive factors of respiratory sequelae of laryngotracheobronchial foreign body inhalation. METHODS: This retrospective study was conducted in the children hospital of Tunis during a period of nine years (2000 - 2008). In all statistical tests, the significance level was set at 0.05. RESULTS: 60 children were included in the study. The average age was 24.9 +/- 3.4 months. 2 / 3 of the children were boys. The foreign body was plant in 80% of cases. The penetration syndrome was reported in 83.7% of cases. The average time of stay of foreign body was 14 days. The chest radiograph was abnormal in 77.4% of cases. Endoscopic extraction was performed in 59 cases and a pneumectomy was conducted in one child. 30 children were followed for an average of 23 months. 18 children had not respiratory sequelae (clinical, radiological and scintigraphic). 10 children had respiratory sequelae (clinical and radiological and/or scintigraphic) at the last follow-up and four patients developed bronchial dilatation. Respiratory sequelae were correlated with the stay period of the foreign body exceeding 84H. Neither age, nor sex, nor the nature of foreign body or its location, nor the presence of radiological opacity at the initial radiograph, were predictive factors of respiratory sequelae. CONCLUSION: The inhalation of foreign body is a serious accident affecting essentially male infants. Clinical, radiological and scintigraphic follow up is mandatory.
Subject(s)
Foreign Bodies/complications , Foreign Bodies/therapy , Bronchoscopy , Child , Child, Preschool , Female , Foreign Bodies/diagnostic imaging , Humans , Infant , Lung/diagnostic imaging , Lung Diseases/etiology , Male , Radiography , Retrospective StudiesABSTRACT
Solitary fibrous tumours of the pleura are usually benign. However, malignancy is observed in 13% of the cases. The authors report two cases of 27 and 69 year-old patients, presenting chest pain and dyspnoea. The roentgenograms and computed tomography scanning revealed a pleural tumour in both cases. The patients underwent complete resections of these tumours. The immunohistochemical study confirmed the diagnosis of malignant solitary pleural fibroma. The patients succumbed to their disease secondary to local recurrences. Histopathology is very helpful in the diagnosis of malignant pleural fibroma. Surgery and long-term follow-up are mandatory.
Subject(s)
Solitary Fibrous Tumor, Pleural , Adult , Aged , Humans , Male , Solitary Fibrous Tumor, Pleural/diagnosis , Solitary Fibrous Tumor, Pleural/surgerySubject(s)
Chromosomes, Human, Pair 6/genetics , Mutation, Missense , Polycystic Kidney, Autosomal Recessive/genetics , Receptors, Cell Surface/genetics , Consanguinity , Esophageal and Gastric Varices/genetics , Exons/genetics , Female , Genetic Markers/genetics , Genetic Testing , Genotype , Hematemesis/genetics , Hepatomegaly/genetics , Humans , Infant , Phenotype , Polycystic Kidney, Autosomal Recessive/diagnosis , Splenomegaly/genetics , TunisiaABSTRACT
Langerhans cell histiocytosis, previously known as histiocytosis X, is a disease whose clinical presentation varies. Although it is uncommon, Langerhans cell histiocytosis may involve the perianal region. We report the case of a 2-year-old boy who presented with perianal ulcerated vegetative lesions and seborrheic dermatitis of the scalp. Biopsy of the lesions showed Langerhans cell histiocytosis. This patient did not have any other organ involvement, which is rare. The outcome was favourable with vinblastine and corticoids.
Subject(s)
Anus Diseases/etiology , Histiocytosis, Langerhans-Cell/diagnosis , Antineoplastic Agents, Phytogenic/therapeutic use , Anus Diseases/drug therapy , Child, Preschool , Dermatitis, Seborrheic/drug therapy , Dermatitis, Seborrheic/etiology , Glucocorticoids/therapeutic use , Histiocytosis, Langerhans-Cell/drug therapy , Humans , Male , Prednisone/therapeutic use , Vinblastine/therapeutic useSubject(s)
Celiac Disease/complications , Focal Nodular Hyperplasia/complications , Sjogren's Syndrome/complications , Celiac Disease/diagnosis , Child , Esophageal and Gastric Varices/complications , Female , Focal Nodular Hyperplasia/diagnosis , Hepatomegaly , Humans , Hypertension, Portal/complications , Sjogren's Syndrome/diagnosis , SplenomegalyABSTRACT
A male infant with partial monosomy 10 q and partial trisomy 11q as a result of de novo unbalanced translocation between the long arms of chromosomes 10 and 11: der(10)t(10;11)(q26;q13) is described. He had craniofacial dysmorphy, congenital heart defects, urogenital and cerebral anomalies, and severe developmental delay. To the best of our knowledge, this is the first report of this combination of chromosomal abnormalities.
Subject(s)
Abnormalities, Multiple/genetics , Chromosomes, Human, Pair 10/genetics , Chromosomes, Human, Pair 11/genetics , Monosomy/genetics , Translocation, Genetic , Trisomy/genetics , Humans , Infant , Karyotyping , MaleABSTRACT
Hemothorax is generally secondary to trauma, invasive thoracic surgery or specific lung of pleural disease. Hemothorax secondary to aortic dissection is rare. We report a case in a 69-year-old man with a history of smoking and hypertension. The patient was referred for exploration of a left pleural opacity with mediastinal widening. Pleural puncture produced a hemorrhagic fluid. The thoracic scan led to the diagnosis of Stanford type B aortic dissection. The patient was given antihypertensive treatment and now has a sixteen month follow-up. Aortic dissection can give rise to hemothorax, especially in a hypertensive subject with an anomalous aortic arch or mediastinal widening on the chest X-ray. Computed tomography generally gives the diagnosis. Treatment may be medical or surgical, depending on the site of the lesion and the severity of the clinical presentation. Aortic dissection is a cause of hemothorax, particularly in patients with favorable conditions or a suggestive radiological anomaly.
Subject(s)
Aortic Aneurysm, Thoracic/complications , Aortic Dissection/complications , Hemothorax/etiology , Aged , Humans , MaleABSTRACT
Solitary plasmocytoma is a rare tumor accounting for 5% of all plasma cell neoplasias. The diagnosis is based on identification of the localized tumor composed of monoclonal plasma cells identical to those observed in multiple myeloma, and absence of the signs in favor of a disseminated form. We report the case of a52-year-old man who presented a growth of the chest wall in the left axillary region. Imaging disclosed a mass of tissue with a large zone of osteolysis of the 6th rib and infiltration of the chest wall. Surgical biopsy for pathology study and immunohistochemistry enabled the diagnosis of costal plasmocytoma. Blood protein immunoelectrophoresis revealed a monoclonal kappa type IgG. Bence-Jones proteinuria was positive. Search for other localizations was negative and the diagnosis of solitary plasmocytoma was retained. Radiotherapy was delivered and the patient has remained in remission at one year. Costal localization is rare for solitary plasmocytoma. The diagnosis is based on imaging findings and pathology. Radiotherapy is the treatment of choice but with the risk of progression with other bone lesions, the development of medullary plasmocytosis and multiple myeloma. Factors predictive of systemic recurrence have not been identified. Regular surveillance is required.
Subject(s)
Bone Neoplasms/diagnosis , Plasmacytoma/diagnosis , Ribs , Bone Neoplasms/radiotherapy , Humans , Immunoglobulin kappa-Chains/blood , Male , Middle Aged , Plasmacytoma/radiotherapy , Proteinuria/etiologyABSTRACT
Pulmonary hydatid cyst is exceptional in our country. The diagnosis is generally established on the basis of imaging. Surgical treatment is indicated in most patients. We report a case of pulmonary hydatid cyst in a 74-year-old smoker (11 package-years) who presented cough with mucopurulent expectoration and occasional hemoptysis. The chest x-ray demonstrated a poorly delimited heterogeneous opacity in the upper third of the left lung which persisted after antibiotic therapy. Bronchial fibroscopy revealed a hydatid membrane in the left superior bronchus which was totally removed by aspiration. A control radiography after the fibroscopy demonstrated a clear regression of the opacity. A thoracic CT-scan was performed and revealed a residual cavity in the left upper lobe with bronchial dilatation. The indication for surgery was not retained. Treatment of pulmonary hydatid cyst by endoscopy is an exceptional event. Our exceptional case illustrates an atypical radiological presentation and the use of "therapeutic" fibroscopy.
Subject(s)
Bronchoscopy , Echinococcosis, Pulmonary/surgery , Aged , Animals , Cough/parasitology , Echinococcosis, Pulmonary/diagnosis , Hemoptysis/parasitology , Humans , MaleABSTRACT
Mucoepidermoid carcinoma of the lung is rare. The microscopic findings distinguish low grade and high grade tumors. Conservative surgical resection is appropriate if possible for low grade tumors. For the high grade tumors, combined wide surgical resection and radiotherapy is recommended. We report 10 cases of mucoepidermoid carcinoma of the lung (5 low grade, 5 high grade) in 8 male and 2 female patients with a mean age of 43.9 years. Only 5 of 10 were smokers. All 10 patients underwent surgery. Operative procedures included 8 lobectomies and 2 pneumonectomies. Two patients received radiation therapy postoperatively. Three patients (2 high grade and 1 low grade) died. The other 7 patients were alive without evidence of recurrence.
Subject(s)
Carcinoma, Mucoepidermoid/pathology , Carcinoma, Mucoepidermoid/therapy , Lung Neoplasms/pathology , Lung Neoplasms/therapy , Adult , Aged , Carcinoma, Mucoepidermoid/radiotherapy , Carcinoma, Mucoepidermoid/surgery , Child , Female , Humans , Lung Neoplasms/radiotherapy , Lung Neoplasms/surgery , Male , Middle Aged , Pneumonectomy , Prognosis , Retrospective StudiesABSTRACT
Hydatid pulmonary embolism is a rare condition. Diagnosis is difficult and there is no consensus on treatment. Prognosis is generally poor. We conducted a retrospective analysis of patients hospitalized between 1994 and 2002 who had a diagnosis of hydatid pulmonary embolism. Seven cases were identified. All patients had a cyst which spontaneously ruptured into the bloodstream. All patients were symptomatic. Chest x-ray revealed images of metastatic pulmonary echinococciasis in all patients. Thoracic CT and/or angioscan provided the diagnosis in five patients. In one, the diagnosis was established with pulmonary angiography. For one other, the diagnosis was established at the pathology examination of the surgical specimen. Searching for the primary localization of the hydatid disease revealed hepatic cysts in all patients, associated in one with a cyst in the right atrium. The cardiac cyst was not operated and all hepatic cysts were removed. Embolectomy was performed in one patient. Medical treatment with albendazole was given in five patients. The clinical course was marked by death in two patients, due to abundant hemoptysia. The five other patients are followed regularly and were doing well at six months to five years. The diagnosis of hydatid pulmonary embolisms is basically obtained with imaging. Treatment is surgical resection of the embologenic focus then embolectomy. The role of medical treatment is not clearly defined. The short- and mid-term prognosis is generally poor.
Subject(s)
Echinococcosis, Pulmonary/complications , Pulmonary Embolism/etiology , Adolescent , Adult , Aged , Diagnosis, Differential , Echinococcosis, Pulmonary/diagnosis , Fatal Outcome , Female , Hemoptysis/etiology , Humans , Male , Middle Aged , Prognosis , Pulmonary Embolism/diagnosis , Retrospective StudiesABSTRACT
Idiopathic pulmonary haemosiderosis is a rare disease of unknown etiopathogeny which is characterized by hemoptysis due to alveolar haemorrhage. We report the case of a 16 years-old girl with idiopathic pulmonary haemosiderosis, diagnosed through clinical, radiological, cytological and histopathological data. The finding of myeloperoxydase-anti-neutrophil cytoplasmic antibodies (ANCA) positivity led us to suspect an associated vasculitis which was not further demonstrated.