RESUMO
Cutaneous tuberculosis with lymphatic spread is rarely described. We report the case of a woman aged 38, immunocompetent, working in a fruit sorting center, who consulted us for ulceration of the left third finger that had persisted for four months, following a prick from a prickly pear. Physical examination revealed a nodular, erythematous, and ulcerative lesion of the left third finger, associated with inflammatory subcutaneous nodules arranged in a line along the ipsilateral upper extremity and an ipsilateral axillary lymph node. Laboratory tests and chest X-ray were normal. Pathological examination revealed granulomatous chronic inflammation without necrosis. PCR detected DNA from Mycobacterium tuberculosis. No extracutaneous tuberculosis locations were detected. A tuberculous chancre by direct inoculation was therefore diagnosed. The patient received quadruple therapy (rifampicin + isoniazid + pyrazinamide + ethambutol) for 2 months, followed by a combination therapy based on isoniazid and rifampicin for 6 months. Marked regression of the cutaneous lesions occurred after 1 month of first-line therapy. A tuberculous chancre is a rare form of cutaneous tuberculosis, with possible lymphatic spread, in immunocompromised patients but also in immunocompetent children and young adults.
Assuntos
Tuberculose Cutânea/complicações , Tuberculose dos Linfonodos/etiologia , Adulto , Feminino , Humanos , Imunocompetência , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/tratamento farmacológico , Tuberculose dos Linfonodos/diagnóstico , Tuberculose dos Linfonodos/tratamento farmacológicoRESUMO
This study is the first one that describes the situation of Legionnaires' disease (LD) in Tunisia, with its clinical and epidemiological characteristics and investigates the risk factors associated with Legionella infections in our country. We conducted a retrospective multicentric study during 5 years (2008-2012) concerning all confirmed LD cases in Tunisia and we investigated risk factors for infection. The total of confirmed LD cases was 14. Incidence was 0.03. Mean age: 53.1, sex ratio (M/F): 2.6. Summer-autumnal peak was noted. Risk factors for infection were: the great humidity at home (n=4), living in community (n=3) and practice ablutions (before prayer) in public places (n=4). Community acquired legionellosis (n=9) and nosocomial (n=2). Pulmonary symptoms (n=11)+/-gastrointestinal (n=6) and/or neurological signs (n=4). Beta lactams therapy failed (n=11). CXR showed bilateral lesions (n=6). Abnormalities in laboratory values were noted: hyponatremia (n=9), high CPK levels (n=9). Diagnosis was confirmed by positive urinary Legionella antigens test (n=10) and by direct immunofluorescence (n=1). Treatment was based on bitherapy (n=10). Five patients died. The incidence of LD appears lower than other countries. Some risk factors, as ablutions, are different from that reported in Western countries and seem to be specific to our society. Given the seriousness of its consequences, it is strongly recommended to improve the national surveillance system up and register LD as notifiable disease.
Assuntos
Unidades de Terapia Intensiva/estatística & dados numéricos , Doença dos Legionários/epidemiologia , Idoso , Antibacterianos/uso terapêutico , Antígenos de Bactérias/urina , Banhos , Líquido da Lavagem Broncoalveolar/microbiologia , Infecções Comunitárias Adquiridas/epidemiologia , Comorbidade , Infecção Hospitalar/epidemiologia , Suscetibilidade a Doenças , Feminino , Hospitais Universitários/estatística & dados numéricos , Habitação , Humanos , Umidade , Incidência , Legionella/isolamento & purificação , Doença dos Legionários/diagnóstico , Doença dos Legionários/tratamento farmacológico , Doença dos Legionários/transmissão , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Estações do Ano , Fumar/epidemiologia , Fatores Socioeconômicos , Tunísia , Microbiologia da ÁguaRESUMO
During a 2-year period in 2005 and 2006, 64 multidrug-resistant Providencia stuartii isolates, including 58 strains from 58 patients and 6 strains obtained from the same tracheal aspirator, were collected in a burn unit of a Tunisian hospital. They divided into four antibiotypes (ATB1 to ATB4) and three SmaI pulsotypes (PsA to PsC), including 49 strains belonging to clone PsA (48 of ATB1 and 1 of ATB4), 11 strains to clone PsB (7 of ATB2 and 4 of ATB3), and 4 strains to clone PsC (ATB3). All strains, except for the PsA/ATB4 isolate, were highly resistant to broad-spectrum cephalosporins due to the production of the plasmid-mediated CMY-16 ß-lactamase. In addition, the 15 strains of ATB2 and ATB3 exhibited decreased quinolone susceptibility associated with QnrA6. Most strains (ATB1 and ATB3) were gentamicin resistant, related to an AAC(6')-Ib' enzyme. All these genes were located on a conjugative plasmid belonging to the incompatibility group IncA/C(2) of 195, 175, or 100 kb. Despite differences in size and in number of resistance determinants, they derived from the same plasmid, as demonstrated by similar profiles in plasmid restriction analysis and strictly homologous sequences of repAIncA/C(2), unusual antibiotic resistance genes (e.g., aphA-6), and their genetic environments. Further investigation suggested that deletions, acquisition of the ISCR1 insertion sequence, and integron cassette mobility accounted for these variations. Thus, this outbreak was due to both the spread of three clonal strains and the dissemination of a single IncA/C(2) plasmid which underwent a remarkable evolution during the epidemic period.
Assuntos
Antibacterianos/administração & dosagem , Surtos de Doenças , Farmacorresistência Bacteriana Múltipla/genética , Infecções por Enterobacteriaceae/epidemiologia , Providencia/genética , beta-Lactamases/genética , Adolescente , Adulto , Idoso , Técnicas de Tipagem Bacteriana , Unidades de Queimados , Cefalosporinas/administração & dosagem , Criança , Enzimas de Restrição do DNA/metabolismo , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/microbiologia , Feminino , Transferência Genética Horizontal , Gentamicinas/administração & dosagem , Humanos , Integrons/genética , Masculino , Pessoa de Meia-Idade , Mutagênese Insercional , Plasmídeos , Providencia/efeitos dos fármacos , Providencia/isolamento & purificação , Deleção de Sequência , Tunísia/epidemiologiaRESUMO
OBJECTIVE: Epidemiology of human herpesvirus 8 (HHV8) is still unknown in Tunisia. We aimed to assess the prevalence of HHV8 infection in adults and children from Central-East Tunisia and in patients with high risk of parenteral or sexual infection. METHODS: We enrolled 553 subjects: 116 blood donors, 100 pregnant women, 100 children, 50 subjects with sexually transmitted infections with positive HIV serology and 50 other without HIV infection, 107 multitransfused patients and 30 kidney transplant patients. Antibodies against HHV8 were tested using a sensitive indirect immunofluorescence assay. RESULTS: The seroprevalence of HHV8 was found to be 13.8% in blood donors, 13% in pregnant women and 12% in children. In healthy adult population, no association was found between HHV8 seropositivity and sex, sociodemographic characteristics, parenteral risk factors or serological markers of hepatitis B. Rates of HHV8 infection were significantly higher in patients having high-risk sexual behavior with or without HIV infection (P<10(-4)), in polytransfused patients (P<10(-4)) and in patients with kidney transplantation (P=0.001). CONCLUSION: Our findings suggest that HHV8 infection is widespread in Central-East Tunisia such as in the Mediterranean area. HHV8 infection appears to be acquired early in life, probably through saliva. HHV8 transmission by blood transfusion, subject of controversy in literature, is well established in our study. Early screening of this infection should be considered in populations with high risk of Kaposi's sarcoma in our areas.
Assuntos
Infecções por Herpesviridae/epidemiologia , Infecções por Herpesviridae/etiologia , Herpesvirus Humano 8 , Adolescente , Adulto , Anticorpos Antivirais/sangue , Criança , Pré-Escolar , Feminino , Infecções por Herpesviridae/transmissão , Herpesvirus Humano 8/imunologia , Herpesvirus Humano 8/isolamento & purificação , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/etiologia , Fatores de Risco , Estudos Soroepidemiológicos , Comportamento Sexual/fisiologia , Infecções Sexualmente Transmissíveis/sangue , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/etiologia , Infecções Sexualmente Transmissíveis/transmissão , Tunísia/epidemiologia , Adulto JovemRESUMO
A 9-year old girl with a history of diabetes mellitus type 1, presented with visual loss of the left eye. The right eye examination was unremarkable. Slit-lamp examination revealed few small and fine keratic precipitates. We noted 2+ flare in the vitreous. There was no choroiditis, papillitis or retinal vasculitis. No aetiology was found. The patient was treated by topical and systemic corticosteroids without any improvement. Celiac disease was discovered by the presence of celiac antibodies in the work-up of joint pain and diabetes mellitus type 1. Antiendomysium antibodies and anti-transglutaminase antibodies were both positive. A small bowel biopsy confirmed celiac disease. A gluten free diet was set up and corticosteroids were tapered off. Recovery of the uveitis was obvious during gluten free diet and normalized within two months.
Assuntos
Doença Celíaca/diagnóstico , Diabetes Mellitus Tipo 1/complicações , Dieta Livre de Glúten , Uveíte/dietoterapia , Uveíte/etiologia , Doença Celíaca/complicações , Doença Celíaca/dietoterapia , Criança , Feminino , HumanosRESUMO
Cytotoxic chemotherapy suppresses the haematopoietic system, febrile neutropenia is the most serious haematological toxicity associated with the risk of life-threatening infections. We present a retrospective study of 200 episodes of febrile neutropenia in 128 patients treated in department of medical oncology. The aim of this study was to determinate the clinical, therapeutic and evolutive characteristics in patients treated essentially for solid tumors. Among these patients, 72% of them have at least two episodes, the median age was 34 years with extremes six and 75 years. It has been noticed that 26.3% of patients have diabetes, the dominate neoplasm was solid tumors in 79.7%, 65% of patients have received preventive colony-stimulating factors, 83% have received preventive buccal disinfection with antifungic. The median duration of hospitalisation was 12 days, the median delay of febrile neutropenia was 10 days with extremes two and 31 days, median duration of febrile neutropenia was 5.45 days with extremes one and 24 days. Among these cases, 9.45% of them have nadir zero, 68% of patients have clinical documented infections, ORL in 47% of cases. According to the study, 12% of cases have documented microbiological fever, the sites was urinary in 33% of cases, blood in 33% of cases, derm in 30% of cases. The microbe was staphylococcus negative coagulase in 37.5% essentially in blood and derm, the Escherichia coli in 20.8% essentially in urinary and blood. First line antibiotherapy was cefotaxim associated with amikacine in 93.5%, second line antibiotherapy was association of imipenam and amikacine in 82% of cases. Among these cases,7% of them have received anti-staphylococcus, and antifungic treatment in 50% of cases. The thermic defervescence was obtained in median delay of 2.8 days. We have noted nine deaths (22% of cases). Recent surveys indicate that neutropenia remains a prevalent problem associated with substantial morbidity, mortality and costs. The colony-stimulating have used effectively in a variety of clinical settings to prevent or treat febrile neutropenia and to assist patients receiving dose-intensive chemotherapy.
Assuntos
Neutropenia/induzido quimicamente , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Antineoplásicos/efeitos adversos , Infecções Bacterianas/complicações , Infecções Bacterianas/tratamento farmacológico , Criança , Pré-Escolar , Febre/etiologia , Humanos , Lactente , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Neutropenia/tratamento farmacológico , Neutropenia/etiologia , Estudos RetrospectivosRESUMO
OBJECTIVE: To determine the rate and risk factors for group B streptococcus (GBS) colonization in term pregnancies. PATIENTS AND METHODS: Vaginal and anal cultures were prospectively conducted in 294 parturient on admission for term vaginal delivery. RESULTS: Thirty-eight (12.92%) parturient had positive GBS cultures. None of the studied risk factors (age, education status, nulliparity, previous obstetric problem, twin pregnancy and diabetes) was statistically predictive of maternal colonization. All the isolated GBS were sensitive to the penicillin G. DISCUSSION AND CONCLUSION: Systematic screening strategy of GBS close to the delivery on all pregnant women is desirable.
Assuntos
Antibacterianos/uso terapêutico , Portador Sadio/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Infecções Estreptocócicas/epidemiologia , Streptococcus agalactiae , Adulto , Canal Anal/microbiologia , Portador Sadio/diagnóstico , Portador Sadio/tratamento farmacológico , Feminino , França , Humanos , Programas de Rastreamento , Penicilinas/uso terapêutico , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Estudos Prospectivos , Fatores de Risco , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Vagina/microbiologiaAssuntos
Neoplasias Hematológicas/tratamento farmacológico , Neutropenia/complicações , Infecções por Pseudomonas/etiologia , Sepse/etiologia , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Feminino , Humanos , Leucemia/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Neutropenia/induzido quimicamente , Prognóstico , Infecções por Pseudomonas/patologia , Sepse/mortalidade , Resultado do TratamentoRESUMO
The epidemiology of pulmonary colonisation by Pseudomonas aeruginosa was studied in 21 patients with cystic fibrosis (CF) by field inversion gel electrophoresis. DraI-DNA restriction patterns were analysed for 187 P. aeruginosa isolates from these patients. The results revealed that the strains present in individual patients varied during the course of chronic colonisation; the emergence of new strains often was associated with periods of antibiotic therapy. Patients often were colonised by more than one strain (two or three strains were present in 54% of the patients) and the strains obtained from unrelated patients were highly heterogeneous, in contrast to those isolated from a pair of twins. These results demonstrate the heterogeneity and variability of P. aeruginosa isolates in the pulmonary flora of chronically infected CF patients.