[Dermatomycosis due to Trichophyton verrucosum in Sfax-Tunisia]. / Les dermatomycoses àTrichophyton verrucosum à Sfax-Tunisie.

UNLABELLED: Trichophyton verrucosum is a zoophilic dermatophyte. It can be responsible of various clinical aspects especially inflammatory lesions of skin and scalp. The aim of this study was to determine the clinical and epidemiological characteristics of dermatophytosis due to T. verrucosum. PATIENTS AND METHODS: It is a retrospective study realized on 35,918 patients suspected to have superficial mycoses in a 13-year-period (from 1998 to 2010). RESULTS: T. verrucosum was isolated in 178 patients corresponding to 1.2% of all dermatophytosis. Ochraceum variety was the most frequent (60%), followed by album variety (40%). Frequency of isolated T. verrucosum increased passing from one case in 1998 to 37 cases in 2010. The mean age was 22.7 years (range: 1.5-71 years). A percentage of 74.2 of our patients were male and 61% were from urban regions. A percentage of 32.5 could link their clinical lesions to contact with an animal (mainly cattle and sheep). Other family members were infected by tinea in 7.3% of cases. Tinea corporis was the most frequent (62.2%), followed by tinea capitis (31.6%). Ten cases of sycosis, one case of tinea pedis and one case of pubic tinea were diagnosed. Lesions of skin were erythemato-squamous (82.5%) and pustulo-inflammatory (17.5%), affecting mainly upper limb (58.3%) and face (25.8%). For tinea capitis, lesions were squamous (30.8%) and pustulo-inflammatory (41%). Eleven cases of kerion celsi were diagnosed (28.2%). Patients were affected in one site (79.7%), two sites (16.9%) and three or more (3.4%). CONCLUSION: Dermatophytosis due to T. verrucosum is in recrudescence in our region. This finding may be explained by changing behaviors and activities of the population with a low socioeconomic level who kept a larger number of domestic animals at homes.

[Acanthamoeba keratitis: about the first two Tunisian cases]. / Les kératites amibiennes: à propos des deux premiers cas tunisiens.

Acanthamoeba keratitis is a rare but severe corneal infection which, despite improvements in diagnosis and treatment, still culminates in prolonged morbidity and significant loss of visual acuity. We present the case report of the first identification of Acanthamoeba as a causative agent of keratitis in Tunisia. Case no 1: A 20-year-old girl, nearsighted corrected with soft contact lenses, suffering from a deep corneal inflammation and poor visual acuity The ophthalmological examination showed bilateral dendritiform epithelial keratitis. The illness did not respond to topical and general antibiotic treatment and developed bilateral corneal abscess. Microscopic examination and culture of samples from cornea scraping revealed the presence of trophozoit and cysts of Acanthamoeba associated with Fusarium oxysporum. As the treatment with local Ketoconazol and antibiotherapy didn't show any result, two transfixiant keratoplasty were carried out and treatment by Désomédine, PHMB (polyhexamethylene biguanide) and Voriconazol was started. After two months, the patient felt better, vision was also improved (2/10) and infiltrates became smaller Case no 2: A 19-year-old girl, nearsighted with soft contact lenses consulted for a bilateral corneal ulceration and poor vision (1/20). Trophozoit and cysts of Acanthamoeba were found in the contact lens solution. She was treated quickly with Désomédine. Visual acuity improved to 7/10 but the corneal ulceration left a residual opacity

[Parasitoses and immunodepression]. / Parasitoses et immunodépression.

The immunodepression, related or not to AIDS, induces the emergence of opportunistic parasitosis and mycosis. Our objective is to analyze these pathogenic agents, their clinical expression and gravity in immunocompromised individuals. Our retrospective 9 years study reported parasitic and fungic infections complicating immunodepression. Among 31 HIV infected patients, we diagnosed the following parasitosis: Cryptosporidium (7 cases), Isospora belli (2 cases) and Enterocytozoon bieneusi (1 case). Pulmonary pneumocystosis was diagnosed in 6 cases, cerebral toxoplasmosis in 6 cases and meningo-cerebral cryptococcosis in 1 case. The systemic candidasis was diagnosed in 13 leukaemic patients. The intestinal anguilluliasis was found in 5 patients treated with corticoïds for long periods. A case of Kala azar was observed in a 83 years man treated with corticoïds. A disseminated aspergillosis occurred in a child with a Chediack Higashi syndrome. A gingivo-labial fusariosis was diagnosed in a leukaemic patient. This emergency of the new parasitic and fungal agents requires a better understanding of these affections in order to improve their early diagnosis and treatments.