Neurological variant of Lemierre's Syndrome with purulent meningitis: a case report and literature review.

We report an unusual variant of Lemierre's Syndrome (LS) in a 10-year-old-girl admitted to the intensive care unit for septic shock with meningitis. The primary infection was otitis media. A gram negative bacillus was identified in the direct exam of the purulent ear discharge and the cerebrospinal fluid but cultures were negative. Computerized tomography of the neck revealed a thrombus in the internal jugular vein. Septic shock improved rapidly under supportive treatment. The patient recovered without sequellae after a prolonged duration of parenteral antibiotherapy and hospital stay. Neurologic variants of LS with meningitis, previously reported in the literature, are reviewed.

Fatal subdural empyema caused by Streptococcus constellatus and Actinomyces viscosus in a child--case report.

Group milleri streptococci that colonize the mouth and the upper airways are generally considered to be commensal. In combination with anaerobics, they are rarely responsible for brain abscesses in patients with certain predisposing factors. Mortality in such cases is high and complications are frequent. We present a case of fatal subdural empyema caused by Streptococcus constellatus and Actinomyces viscosus in a previously healthy 7-year-old girl.

[Phenotyping and antibiotic susceptibility's study of Neisseria meningitidis strains isolated at the "Hôpital d'Enfants" of Tunis]. / Typage phenotypique et etude de la sensibilite aux antibiotiques des souches de neisseria meningitidis isolees a l'Hopital d'Enfants de Tunis (mars 1998 - fevrier 2004).

A total of 23 invasive strains of Neisseria meningitidis were isolated between March 1998 and February 2004. 19 strains were recovered from cerebrospinal fluid (CSF) and 4 from blood. The majority of these strains were recovered from children with an age less to 4 years (86.9%). The antigenic formula'study (serogroup:serotype:serosubtype) of the strain's collection have shown there great diversity. The sero-group B was the most frequent (83%) followed by serogroup C (17%). The B:NT:NST phenotype was major among strains of the serogroup B and the C:4:P1-14 phenotype among strains of the serogroup C. No beta-lactamase activity was detected. 30.4% of the strains were of diminished susceptibility to penicillin G (CM190 = 0.38 Ig/ml). No resistance to amoxicillin (CMI90 = 0.19 microg/ml), to cefotaxime (CMI90 = 0.016 microg/ml) and to rifampin (CMI90-0.125 microg/ml) was detected; whereas 8.7% of strains-were resistant to chloramphenicol (CMI90=2 Ig/ml) and 65.2% to spiramycin.

[Antibiotic resistance among E. coli isolates from urinary tract infections (1999-2000): a multicenter study]. / Sensibilite aux antibiotiques des souches urinaires d'E. coli (1999-2000): resultats d'une étude multicentrique.

E. coli is the most frequently isolate species in community as well as in nosocomial acquired urinary tract infections (UTI). Trimethoprim-sulfamethoxazole (TMP-SMX), is commonly used as empiric treatment for managing uncomplicated UTI whereas the rate of resistance to amoxicilline is increasing. A multicentric retrospective study was conducted from January 1st 1999 to December 31st 2000 to evaluate the prevalence of E. coli isolates from UTI and to guide empiric therapies. Among 6994 urinary isolates, 62.6% were resistant to amoxicilline, this rate fell to 33.6% when amoxicilline was associated to clavulanic acide, 2.7% were producing extended spectrum b-lactamases (BLSE), higher than reported in France and USA. 37.3% were resistant to TMP-SMX. The high prevalence of antimicrobial resistance among UTI E. coli isolates emphasizes the necessity to review the empiric therapies. Fluoroquinolones can be considered as an alternative therapy according to their excellent tissue penetration and their wide spectrum of activity.

[Antibiotic sensitivity of Streptococcus pneumoniae in Tunisia: results of a multicenter study (1998-1999)]. / Sensibilité aux antibiotiques de Streptococcus pneumoniae en Tunisie: résultats d'une étude multicentrique (1998-1999).

We report the results of a multicenter tunisian study, performed over a two-year period (1998-1999), to determine the susceptibility pattern of Streptococcus pneumoniae in our country. A total of 146 S. pneumoniae were collected during the study period. 76 were recovered from adults and 70 from children. 53% of isolates have decreased susceptibility to penicillin, 24% with low level resistance, and 11% with high level resistance. Amoxicillin and cefotaxime decreased susceptibility rates were: 12% (low level resistance exclusively). and 14% (10% with low level resistance and 4% with high level resistance) respectively. Strains isolated from children, showed higher resistance to b lactams than those isolated from adults. Resistance rates to other antibiotics were as follow: erythromycin 28%, choramphenicol 14%, cyclins 23%, thrimethoprim-sulfamethoxazole 28% and rifampin 1%. No vancomycin resistant strain was found. The acquire resistance rates of Streptococcus pneumoniae in Tunisia are worrying, essentially for penicillin and erythomycin. Amoxicillin and cefotaxime have conserved a good activity.

[Epidemiologic profile of Haemophilus influenzae infection in Tunisia]. / Profil épidémiologique des infections à H. influenzae en Tunisie.

Haemophilus influenzae, a commensal bacteria, is frequently incriminated in broncho--pulmonary surinfections and severe diseases as meningitis, pneumonia and septic arthritis, particularly in young children. A multicenter study was conducted to establish the epidemiological profile of Haemophilus influenzae diseases, to determine the rate of antibiotics resistance for guide therapeutic and preventive strategies. The identification was based on the requirements for X and V factors, and the serotype b determined by agglutination. The betalactamase production was done by nitrocefin test. Antimicrobial susceptibility testing was determined on Muller Hinton chocolate agar with isovitalex. During the two year period, (January 1998 December 1999), 192 isolates of H. Influenzae were collected, 61% were recovered from invasive infections (44 meningitis, 8 bacteremia, 2 arthritis). The serotype b was identified in 55.7% of cases, 67.3% were invasive strains. 24.5% of isolates were producing betalactamase particularly invasive serotype b strains. All isolates of H. influenzae were susceptible to cefotaxim and to ofloxacin. Resistance rates to other antibiotics were: erythromycin 56.2%, tetracyclin 10.3%, rifampin 12%, chloramphénicol 1%, cotrimoxazole 16.5%, 11.5% amikacin and 20% gentamicin. The incidence of meningitis remained frequent in our country, involving the introduction of the vaccination in official calendar. Nevertheless, the surveillance of H. influenzae invasives infections and the serotyping of isolates were necessary to evaluate the impact of the immunization.