[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.

[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.

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.

[AIDS in Tunisian women. Study of 92 cases]. / Le sida chez la femme tunisienne. Etude de 92 cas.

The authors report a retrospective study about 92 cases of HIV-1 infections among adult tunisian women hospitalised or consulting in the department of infectious diseases at Rabta hospital over a period of 15 years and 6 months. The middle age is 33.2 years. 64.1% of patients are married, and the conjoint is HIV-1 positive in 84.1% of cases. The route of transmission is sexual in 75%, parenteral in 22.8% and unknown in 2.2%. According to CD4 level and clinical symptoms, patients are at AIDS stage in 75.5%. The main clinical symptoms are: oral candidiasis in 92.4%, diarrhea in 54.3%, pneumocystis carinii pneumoniae in 11.9%, cerebral toxoplasmosis in 10.9%, septicemia caused particularly by salmonella in 9.7%, tuberculosis in 6.7%, cryptococcal meningitis in 4.3% an Kaposi's sarcoma in 3.2%. Mother to child HIV transmission is found in 33.3%, and the mortality is noted in 43.5% of cases.

[Bacterial infections in AIDS (mycobacterial infections excluded): study of 100 cases]. / Infections bactériennes au cours du SIDA (mycobactérioses exclues): étude de 106 cas.

We report a retrospective study of 106 patients with bacterial infections from 322 patients infected with the human immunodeficiency virus (HIV) resulting in 33 percent. Epidemiological profile of bacterial infection in HIV patient is the same that observed in tunisian patient with HIV: a young male infected mainly by sexual route. Bacterial infection is located in the lungs in 38.3 percent, in the skin in 16.5 percent, in upper respiratory tract and oral in 12.7 percent, sexually transmitted disease and bacteremia are respectively found in 12 percent, bacterial genito-urinary tract infection in 5.3 percent, bacterial gastro-intestinal tact infection in 2.3 percent and meningitis in 0.8 percent. Bacterial infections occur at all stages in patients with HIV, but mainly in 77.7 percent at AIDS stage. Regardless the infectious site, granulocytes number is normal in 66 percent of cases. Bacterial investigation find a bacterial specie in 14.3 percent and a bacterial positive serology in 11.2 percent. Mortality caused by bacterial infection is found in 11.3 percent.

[Characterization of HIV-1 subtypes in Sfax, Tunisia]. / Caractérisation des sous-types VIH-1 à SFAX, Tunisie.

UNLABELLED: We studied HIV-1 subtypes in 20 patients, originating from Tunisia in 18 cases and Libya in 2 other cases and seen in Regional Hospital of Sfax during 1993-1997. Among the 18 tunisian patients, 14 are infected by subtype B. Nine of them are living in european countries and were probably infected by intravenous drug and/or sexual route. The five other patients infected by subtype B correspond to autochtonous cases: 3 patients were infected by their partner, 1 was infected by blood transfusion and the last one has had multiple sexual partners. For another tunisian patient, serum cross-reacted with 2 peptides C and B (C/B) corresponding to coinfection or subtype recombination. Two strains were indeterminate by SSEIA. The last tunisian patient, contaminated in Libya, is infected by a strain presenting cross-reactivity with subtype A and C (A/C). This same strain was found in one libyan patient. The second libyan patient is infected by subtype C. CONCLUSION: In Tunisia, we noted the frequency of HIV-1 subtype B, originating from european countries. But, the fear of other HIV-1 subtypes introduction and therefore, the emergency of new recombinants must incite us to a greatest vigilance in survey of HIV-1 infection.

[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.

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.

Epidemic West Nile virus encephalitis in Tunisia.

West Nile fever (WNF) is a mosquito-borne flavivirus infection. It is epidemic in Africa and Asia. In autumn 1997, a WNF epidemic occurred in the Sfax area (southeastern Tunisia). Fifty-seven patients were hospitalized with aseptic meningitis and/or encephalitis. Search for specific anti-West Nile virus (WNV) antibodies in serum and cerebrospinal fluid (CSF) was performed using an ELISA test. Reverse transcriptase-polymerase chain reaction (RT-PCR) was used to detect the WNV genome in CSF and brain specimens. Recent central nervous system (CNS) infection by WNV was confirmed in 30 patients, probable infection in 17 and it was excluded in 10. In the confirmed subgroup, patients with encephalitis were older than those with meningitis. CSF showed pleocytosis, high protein (47%) and normal glucose levels. Brain computed tomography-scan (CT-scan) and magnetic resonance imaging (MRI) were normal. RT-PCR disclosed WNV genome in the CSF in two cases and in a brain specimen in one. Three patients died rapidly, the remaining cases had favorable prognosis. Autopsy was performed in two cases and showed nonspecific lesions of encephalitis. No viral inclusions were seen with light microscopy. Seropositivity rate in patients' proxies for WNV was 23.4%. Prognosis of CNS involvement during WNF seemed to be poor in older patients. This is the first WNV encephalitis epidemic report in the Sfax area of Tunisia.