Pseudo-tumeur inflammatoire cardiaque mimant un myxome.

La pseudo-tumeur inflammatoire de localisation cardiaque est une entité rare et bénigne. Elle peut souvent mimer une tumeur maligne dans sa présentation clinique et radiologique, pouvant entrainer un retard diagnostic. Nous rapportons le cas d'un patient âgé de 20 ans, sans antécédents médicaux, admis dans le service pour l'exploration d'une fièvre prolongée. Un myxome du ventricule droit a initialement été suspecté sur l'imagerie. Une résection complète de la masse cardiaque a été effectuée. L'étude histopathologique a conclu à une pseudo-tumeur inflammatoire. Ce cas vise à présenter les caractéristiques cliniques, radiologiques, histologiques ainsi que la prise en charge d'une pseudo-tumeur inflammatoire cardiaque.

Cerebro-rhino-orbital mucormycosis and aspergillosis coinfection in a patient with diabetes mellitus: A case report.

Opportunistic fungal infections are life-threatening conditions with a high rate of morality, mostly occurring in immunocompromised hosts. We reported the case of mixed mold infection in a 69 year-old patient with latent diabetes mellitus. She was initially admitted for right orbital cellulitis. Cerebro-rhino-orbital mucormycosis and aspergillosis coinfection was diagnosed from mycological testing and histology after nasal biopsy sample. The patient received amphotericin B deoxycholate then voriconazole combined to surgical debridement with a favorable outcome.

[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.

Mucormycosis: four case reports.

INTRODUCTION: Mucormycosis is a rare and invasive fungal infection, but frequently fatal when it occurs. It commonly affects patients with diabetes mellitus. The aim of this study is to assess the clinical presentation, radiological findings, management and prognosis of mucormycosis. METHODS: This retrospective study was conducted in the department of infectious diseases of Rabta hospital between January 1988 and December 2004 and included patients hospitalized for mucormycosis confirmed by mycological and/or histological findings. RESULTS: the study is about four diabetic patients with mucormycosis (3 men and a woman). Three of them had diabetic ketoacidosis at the time of diagnosis. The infection was sinusal in 2 cases and rhinocerebral in the the other two cases. Treatment consisted in systemic amphotericin B combined with surgical debridement in 3 cases. A fatal outcome was noted in 2 cases. CONCLUSION: Mucormycosis remains a severe infectious disease in diabetic patients. Early diagnosis and treatment is mandatory for a successful management of this infection.

[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.

Availability of hepatitis C diagnostics and therapeutics in European and Eurasia countries.

BACKGROUND: Treatment with direct acting antiviral agents (DAAs) has provided sustained virological response rates in >95% of patients with chronic hepatitis C virus (HCV) infection. However treatment is costly and market access, reimbursement and governmental restrictions differ among countries. We aimed to analyze these differences among European and Eurasian countries. METHODS: A survey including 20-item questionnaire was sent to experts in viral hepatitis. Countries were evaluated according to their income categories by the World Bank stratification. RESULTS: Experts from 26 countries responded to the survey. As of May 2016, HCV prevalence was reported as low (≤1%) in Croatia, Czech Republic, Denmark, France, Germany, Hungary, the Netherlands, Portugal, Slovenia, Spain, Sweden, UK; intermediate (1-4%) in Azerbaijan, Bosnia and Herzegovina, Italy, Kosovo, Greece, Kazakhstan, Romania, Russia, Serbia and high in Georgia (6.7%). All countries had national guidelines except Albania, Kosovo, Serbia, Tunisia, and UK. Transient elastography was available in all countries, but reimbursed in 61%. HCV-RNA was reimbursed in 81%. PegIFN/RBV was reimbursed in 54% of the countries. No DAAs were available in four countries: Kazakhstan, Kosovo, Serbia, and Tunisia. In others, at least one DAA combination with either PegIFN/RBV or another DAA was available. In Germany and the Netherlands all DAAs were reimbursed without restrictions: Sofosbuvir and sofosbuvir/ledipasvir were free of charge in Georgia. CONCLUSION: Prevalence of HCV is relatively higher in lower-middle and upper-middle income countries. DAAs are not available or reimbursed in many Eurasia and European countries. Effective screening and access to care are essential for reducing liver-related morbidity and mortality.

[AIDS-associated Kaposi's sarcoma: 22 cases]. / Maladie de Kaposi associee au SIDA: etude de 22 cas.

BACKGROUND: Kaposi's sarcoma is the most common acquired immune deficiency syndrome (AIDS)-associated malignancy. Our aim was to analyse the epidemiological, clinical, therapeutic findings in AIDS patients with Kaposi's sarcoma. METHODS: This was a retrospective chart review of AIDS patients with Kaposi's sarcoma diagnosed between 1991 and 2005. Epidemiological data, the stage of human immunodeficiency virus's (HIV) infection, clinical characteristics of Kaposi's sarcoma, treatment rendered and outcome were collected. The search of HHV8 was not done. RESULTS: Twenty two patients were included. They were 17 men and 5 females (sex-ratio=3.4/ 1) with a mean age of 33.6 years at the diagnosis of HIV infection. The Kaposi's sarcoma appeared after a period varying between 0 and 10 years. The Kaposi's sarcoma uncovered the infection in 5 cases. There were 6 homosexual men. The mean rate of CD4 was 216 21/mm3 at the diagnosis of Kaposi's sarcoma. All patients had skin lesions. Mucocutaneous lesions were isolated in 12 cases and associated with visceral involvement in 10 cases; lung (10 cases), gastrointestinal tract (5 cases), lymphadenopathy (5 cases), liver (4 cases), spleen (2 cases). Antiretroviral therapy was prescribed for 13 patients. Six patients received chemotherapy and 3 others radiotherapy. Outcome was favourable in 4 cases with a partial improvement of the skin lesions in 3 cases and a complete regression in 1 case. Twelve patients died. CONCLUSION: AIDS associated Kaposi's sarcoma is a severe condition because of visceral localisations and the field of immunodeficiency. It requires a precocious diagnosis and collaboration. The identification of HHV8 in the aetiopathogenic mechanism of Kaposi's sarcoma can lead to the development new therapeutic approaches.

Seroepidemiology of HCV-HIV coinfection in Tunisia.

AIM: To determine the prevalence of antibodies to hepatitis C virus (HCV) in a cohort of patients infected with human immunodeficiency virus 1 (HIV-1) and to compare risk factors. METHODS: Multicenter retrospective study from infectious diseases department in Tunisia. We examined sera from HIV patients followed in these centers. Diagnosis of HCV infection was based on third generation enzyme-linked immunosorbent assay (ELISA) test. RESULTS: 362 HIV-1 patients were included in the study. The mean age was 35,5 years. 272 patients (75.13%) were male. Sexual transmission of HIV was the main risk factor (56.3%). 144 patients (39.7%) had antibodies against HCV, mainly in patients with history of intravenous drug abuse (78.4%). Quantitative evaluation of hepatitis C virus RNA was done only in 3 patients. CONCLUSION: HCV-HIV coinfection in tunisian patients occurs frequently, due to the same ways of transmission. More studies are needed to focus on sexual transmission of hepatitis C virus in order to prevent such infections rather than interferon-based therapies.

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.

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.

[Transverse myelitis revealing Hodgkin disease]. / Myélite transverse révélant une maladie de Hodgkin.

INTRODUCTION: Neurological complications during Hodgkin disease are rare and sometimes difficult to diagnose. We report the case of a patient with transverse myelitis. CASE: This 32-year-old man was hospitalized on month after onset of febrile spastic paraplegia, which was accompanied by progressive deterioration of his general condition. Examination revealed a febrile, conscious patient, with abolition of the lower-limb tendon reflexes, bilateral Babinski signs, and sensitivity at D6-D7. We also noted hepatosplenomegaly, but no peripheral adenopathies. Laboratory reports indicated bicytopenia, a major inflammatory syndrome and hepatic cytolysis. The computed tomography examination of thorax and abdomen showed swelling in deep lymph nodes and the brain MRI showed what appeared to be transverse myelitis. The brainstem biopsy was normal; the hepatic biopsy showed liver infiltration by Sternberg cells. The patient died rapidly, before treatment could begin. DISCUSSION: The variable neurological events observed during Hodgkin disease may serve to reveal this disease. Their association with a tumor suggests this diagnosis even when the neurological signs are nonspecific. They may affect either the brain or the brainstem. Diagnostic certainty requires histologic analysis, and prognosis depends on early diagnosis and management.

[Association of systemic lupus erythematosus and dermatopolymyositis]. / Association d'un lupus erythémateux systémique et d'une dermatomyosite.

Systemic lupus erythematosus (SLE) associated with dermatopolymyositis (DM). This association is rare. Diagnosis may be difficult because of their common clinical findings. We report here a case. A 22-year-old man was admitted for arthritis with fever, diffuse myalgia and periorbital skin heliotrope rash. Electromyogram and muscular biopsy were suggestive of DM. The patient was treated with oral prednisone. Two months and a half later, he was admitted for impure nephrotic syndrome in relation with diffuse proliferative glomerulonephritis. Antibodies against native double-stranded- DNA were positive, and normal skin biopsy showed immune complex deposit on dermo-epidermic junction, suggestive of SLE. The patient was treated with high doses of prednisone and 6 monthly intravenous pulses of cyclophosphamide. Skin lesions and nephrotic syndrome improved. Presently, the patient remains asymptomatic. While being of different pathogenesis, SLE and DM may coexist in the same patient.

[Relapse of visceral leishmaniasis in HIV infection. Benefit of amphotericin B]. / Rechute de leishmaniose viscerale au cours de l'infection par le VIH interet de l'amphotericine B.

The reference treatment in visceral leishmaniasis is administration of antimonial compounds. Failures have been reported particularly in HIV-positive patients. The authors describe the case of a 40-year-old patient who, after 2 courses of N-methyl-glucamine, relapsed. Bone marrow cultures became negative only after adminstration of amphotericin B (1 mg x kg x d) for 28 days. He is still asymptomatic 18 months after he was cured. Amphotericin B, in case of relapse, seems to be a valuable alternative, until the availability of the liposomal form in our country.

[Efficacy of doxycycline in thoracic actinomycosis: a case report]. / Efficacite de la doxycycline dans l'actinomycose thoracique: a propos d'une observation.

The authors present a case of thoracic actinomycosis in a 32 year-old man with a history of cervico-facial actinomycosis. Diagnosis was made by bacterial examination of purulent drainage from sternal wound showing typical sulfures granules. One year course of doxycycline gives clinical and radiological improvement.

[Effect of triple antiretroviral therapy on Tunisian AIDS profile: study of 139 cases]. / Impact de la trithérapie anti-retrovirale sur le profil evolutif du sideen Tunisien: etude de 139 cas.

We report a retrospective study to estimate highly active antiretroviral therapy (HAART) effect in 139 HIV infected patients. Four criteria are studied: prevalence of opportunistic infections, CD4 cell count evolution, viral load progression and mortality. Gastrointestinal side effects are the most common clinical adverse reaction (61.1 percent), and hematological side effects are the most common biological adverse reaction (61.2 percent). During the 22.8 months (3 months to 6 years) follow-up average period, CD4 cell counts remained above 500 per cubic millimeter in only 25.8 percent of cases, while 63.5 percent of patients had a viral load below 400 copies per milliliter. During the study on patients receiving HAART, opportunistic infections appeared in 17.3 percent of cases (24 cases) and mortality in 6.4 percent of cases.