[Prevalence of alcoholism in primary care in the governorate of Sousse]. / Prevalence de l'alcoholisme en première ligne dans le gouvernorat de Sousse.

BACKGROUND: The prevalence related to alcohol use disorders in adults is 1.7%. It varies around the world. In Tunisia, as in most Arab and Muslim countries, alcohol consumption is still a taboo and little studied. AIMS: To estimate the prevalence of alcohol abuse and dependence Band to assess associated socio-demographic factors in primary care patients in Sousse governorate. METHOD: It's a descriptive study carried out between June and November 2006. The sample included 30 primary care units in Sousse governorate, chosen by a stratified random method. We used the Composite International Diagnostic Interview (CIDI 2.1) translated and validated in Tunisian dialect. RESULTS: Our sample included 2577 participants. The lifetime prevalence of alcohol abuse and during the last 12 months were 2.8% and 1%. Those of alcohol dependence were respectively 0.7% and 0.3%. Only one case of alcohol abuse was found among women and no cases of dependence have been noticed. For men's, the prevalence of alcohol abuse at the lifetime and during the last 12 months were 12.8 % and 4.5 %. For men's alcohol dependence, prevalence rates were 3% and 1.6 %. Associated factors with abuse or alcohol dependence were studied in men's sample (n=560). Alcohol abuse was more common after multivariate logistic regression in the age group betwen18 and 34 years and in those with a diploma. Alcohol dependence was associated with only high level of education. CONCLUSION: Our study provides further evidence that alcohol abuse and dependence in primary care remain low compared to other international studies and highlights the role of primary care physicians in the screening of these health problems especially among men.

Müller cell activation and photoreceptor depletion in a mice model of congenital ocular toxoplasmosis.

Müller glial cells are critically involved in retinal inflammatory processes. Here, we investigate the activation of Müller cells in a model of congenital ocular toxoplasmosis (OT). Four weeks after infection, retinal sections were studied immunohistochemically using the markers glial fibrillary acidic protein (GFAP) and vimentin. Müller cells showed strong up-regulation of both markers, as well as a deteriorated morphology in all infected retinas. Moreover, cell density and color intensity of the outer nuclear layer (ONL) of photoreceptors were decreased. Our results indicate that the severe retinal damage and loss of vision observed in human OT may be not only directly caused by infection but rather mediated by infection induced reactive gliosis.

First isolation and genotyping of Toxoplasma gondii strains from domestic animals in Tunisia.

The isolation and molecular typing of Toxoplasma gondii strains provide an essential basis for a better understanding of the parasite's genetic diversity, determinants of its geographical distribution and associated risks to human health. In this study, we isolated and genetically characterized T. gondii strains from domestic animals in Southern and coastal area of Tunisia. Blood, hearts and/or brains were collected from 766 domestic animals (630 sheep and 136 free-range chickens). Strain isolation from these samples was performed using mouse bioassay and genotyping was carried out with a multiplex PCR technique using 15 microsatellite markers. Thirty viable strains of T. gondii were successfully isolated from tissues of sheep (19/142) and chickens (11/33). In addition, 3 strains could be successfully genotyped from animal tissues for which mouse bioassay was unsuccessful. A large predominance of type II strains (n = 29) was found in the sampled regions, followed by type III (n = 3) and, for the first time in Tunisia, a single isolate of Africa 4 lineage from a sheep. Analyses of population genetics showed the presence of a divergent population of type II lineage in Tunisia, supporting limited recent migrations of strains between Tunisia and other countries of the world.

Murine neonatal infection provides an efficient model for congenital ocular toxoplasmosis.

Congenital infection is one of the most serious settings of infection with the apicomplexan parasite Toxoplasma gondii. Ocular diseases, such as retinochoroiditis, are the most common sequels of such infection in utero. However, while numerous studies have investigated the physiopathology of acquired toxoplasmosis, congenital infection has been largely neglected so far. Here, we establish a mouse model of congenital ocular toxoplasmosis. Parasite load and ocular pathology have been followed for the first 4 weeks of life. Ocular infection developed slowly compared to cerebral infection. Even after 4 weeks, not all eyes were infected and ocular parasite load was low. Therefore, we evaluated a scheme of neonatal infection to overcome problems associated with congenital infection. Development of infection and physiopathology was similar, but at a higher, more reliable rate. In summary, we have established a valuable model of neonatal ocular toxoplasmosis, which facilitates the research of the underlying physiopathological mechanisms and new diagnostic approaches of this pathology.

Seroprevalence of Toxoplasma gondii among healthy blood donors in two locations in Tunisia and associated risk factors.

Toxoplasma gondii is a protozoan parasite that can be transmitted to humans through a variety of routes including blood transfusion. This study aimed to investigate the seroprevalence of T. gondii infection and associated risk factors in healthy blood donors in Tunisia. A total of 800 healthy blood donors from two blood centers in south and coastal Tunisia were analyzed for anti-T. gondii IgG and IgM antibodies by indirect immunofluorescence assay (IFA) and enzyme-linked immunoassays (ELISA), respectively. Structured questionnaires were used to gather information on risk factors for T. gondii infection during collection. The overall seroprevalence was 44.4% of which 352 (44%) and 3 (0.4%) were positive for IgG and both IgG and IgM anti-T. gondii antibodies, respectively. Multivariate analysis showed that T. gondii seropositivity was significantly associated with the birth place (adjusted odds ratio [OR] = 2.72; 95% confidence interval [CI]: 1.49-4.94) and the age of the donors (adjusted OR = 4.98; 95% CI: 1.50-16.58) which are independent risk factors. In addition, the variables of hand washing before eating (adjusted OR = 0.52; 95% CI: 0.37-0.74) and living in an urban environment (adjusted OR = 0.30; 95% CI: 0.13-0.71) are two protective factors. This study provided the first data on the seroprevalence and epidemiology of T. gondii infection in healthy blood donors in Tunisia.

TITLE: Séroprévalence de Toxoplasma gondii chez des donneurs de sang sains dans deux sites en Tunisie et facteurs de risque associés. ABSTRACT: Toxoplasma gondii est un parasite protozoaire qui peut être transmis à l'homme par diverses voies, dont la transfusion sanguine. Cette étude vise à étudier la séroprévalence de l'infection à T. gondii et les facteurs de risque associés chez les donneurs de sang sains en Tunisie. Au total, huit cents donneurs de sang sains de deux centres de transfusion sanguine du sud et de la côte tunisienne ont été analysés respectivement pour la recherche des anticorps IgG et IgM anti-T. gondii par immunofluorescence indirecte (IFA) et par dosage immuno-enzymatique (ELISA). Des questionnaires structurés ont été utilisés pour recueillir des informations sur les facteurs de risque d'infection à T. gondii pendant la collecte. La séroprévalence globale était de 44,4 % dont 352 (44 %) et 3 (0,4 %) étaient respectivement positifs pour les anticorps IgG et IgG/IgM anti-T. gondii. Une analyse multivariée a montré que la séropositivité à T. gondii était significativement associée au lieu de naissance (rapport de côtes ajusté [OR] = 2,72 ; intervalle de confiance à 95 % [IC] : 1,49­4,94) et à l'âge des donneurs (OR ajusté = 4,98 ; IC 95 % : 1,50­16,58) qui sont des facteurs de risque indépendants. De plus, le lavage des mains avant de manger (OR ajusté = 0,52 ; IC 95 % : 0,37­0,74) et vivre dans un milieu urbain (OR ajusté = 0,30 ; IC 95 % : 0,13­0,71) sont deux facteurs de protection. Cette étude a fourni les premières données sur la séroprévalence et l'épidémiologie de l'infection à T. gondii chez les donneurs de sang sains en Tunisie.

First isolation and molecular characterization of Toxoplasma gondii strains from human congenital toxoplasmosis cases in Monastir, Tunisia.

Toxoplasma gondii is a protozoon parasite that can cause severe clinical problems such as congenital toxoplasmosis. The distribution of T. gondii genotypes varies from one geographic area to another. So far, little is known about the parasite genotypes in Tunisia, North Africa. The present study aimed isolating and genotyping T. gondii from the amniotic fluid (AF) and placenta of pregnant women in Monastir, Tunisia. Amniotic fluid and/or placenta from 80 women who acquired toxoplasma infection during pregnancy were tested by PCR and/or mouse bioassay. Genotyping of T. gondii isolates from these samples was performed with 15 microsatellite markers. Four viable T. gondii strains were isolated from either the AF or placenta of four women. Specifically, strains TUN001-MON1 and TUN002-MON2 were isolated from both the AF and placenta, TUN003-AHA from only the placenta, and TUN004-NEL from only the AF. The four viable strains were not virulent for mice. Genotyping revealed that the four strains were type II strains. This is the first report on isolation and genotyping of T. gondii from AF human samples in Tunisia. Further studies focused on T. gondii genotyping on a larger number of human cases and on animals in Tunisia are needed to improve the knowledge and epidemiology of toxoplasmosis.

Parasitological Contamination of Vegetables Sold in Tunisian Retail Markets with Helminth Eggs and Protozoan Cysts.

ABSTRACT: Foodborne diseases continue to represent an important threat to public health in many parts of the world and are particularly widespread in developing countries. They are essentially acquired through an oro-fecal route via the consumption of uncooked fruits and vegetables. This study evaluated the parasitological contamination of vegetables for sale to humans in Tunisian retail markets. A total of 240 samples of fresh vegetables were examined for helminth eggs and protozoan cysts and oocysts (collectively, (oo)cysts) contamination. The parasitic elements (helminth eggs and protozoan (oo)cysts) were concentrated by sucrose flotation and identified by microscopic examination. The molecular identification of Echinococcus granulosus eggs was carried out using PCR. Helminth eggs and protozoan (oo)cysts eggs were found in 12.5% of the unwashed vegetables, and the most common parasites observed in vegetables were coccidian oocysts (4.1%), Toxocara spp. (2.5%), hookworm (2.1%), and Taenia spp. (1.25%) eggs, followed by Pseudolimax butschlii (1.6%) and Entamoeba coli (1.6%) protozoan cysts. Furthermore, parasite contamination differed significantly from one city to another. Taeniid eggs were identified by PCR as E. granulosus sensu stricto (s.s.) (genotype G1). To our knowledge, this study highlights for the first time in Tunisia that fresh vegetables for sale in markets are contaminated with helminths and protozoan cysts, which are potentially pathogenic for humans. The control of these pathogens is in part a question of sanitary education, especially for retail vendors, and in part of improvement in hygiene measures throughout the food production chain, from the field to the consumer.

First report of Tunisian coastal water contamination by protozoan parasites using mollusk bivalves as biological indicators.

In order to establish seawater contamination by emerging protozoan parasites, we used qPCR to molecularly characterize and evaluate the parasitic burden of Giardia duodenalis, Cryptosporidium spp., Toxoplasma gondii, and Cyclospora cayetanensis in 1255 wild bivalve mollusks collected along the Tunisian coasts. T. gondii, G. duodenalis and C. cayetanensis were detected in 6.9% (99% CI=1.6-12.2%) pools of Ruditapes decussatus. None of the samples were found positive to Cryptosporidium spp.; 6.6% pools of R. decussatus were positive for T. gondii Type I, 1.6% for G. duodenalis assemblage A, and 1.6% for the association T. gondii Type I/C. cayetanensis/G. duodenalis assemblage A. R. decussatus harbored up to 77500 oocysts/sample of T. gondii, up to 395 cysts/sample of G. duodenalis, and 526 oocysts/sample of C. cayetanensis. These results provide the first evidence that the Tunisian coasts are contaminated by zoonotic protozoan parasites that can constitute a direct or indirect risk for human health.

The local immune response to intraocular Toxoplasma re-challenge: less pathology and better parasite control through Treg/Th1/Th2 induction.

Ocular toxoplasmosis is a major cause of blindness world-wide. Ocular involvement is frequently seen following congenital infection. Many of these infections are quiescent but pose a life-time risk of reactivation. However, the physiopathology of ocular toxoplasmosis reactivation is largely unexplored. We previously developed a Swiss-Webster outbred mouse model for congenital toxoplasmosis by neonatal injection of Toxoplasma gondii cysts. We also used a mouse model of direct intraocular infection to show a deleterious local T helper 17 type response upon primary infection. In the present study, our two models were combined to study intravitreal re-challenge of neonatally infected mice, as an approximate model of reactivation, in comparison with a primary ocular infection. Using BioPlex proteomic assays in aqueous humour and reverse transcription-PCR for T helper cell transcription factors, we observed diminished T helper 17 type reaction in reinfection, compared with primary infection. In contrast, T helper 2 and T regulatory responses were enhanced. Interestingly, this was also true for T helper 1 markers such as IFN-γ, which was paralleled by better parasite control. Secretion of IL-27, a central cytokine for shifting the immune response from T helper 17 to T helper 1, was also greatly enhanced. We observed a similar protective immune reaction pattern in the eye upon reinfection with the virulent RH strain, with the notable exception of IFN-γ. In summary, our results show that the balance is shifted from T helper 17 to a less pathogenic but more effective anti-parasite Treg/T helper 1/T helper 2 pattern in a reactivation setting.

Cytokine profiles in toxoplasmic and viral uveitis.

BACKGROUND: Uveitis is a major cause of visual impairment throughout the world. Analysis of cytokine profiles in aqueous humor specimens may provide insight into the physiopathological processes that underly retinal damage in this context. METHODS: Using a multiplex assay, we determined the concentrations of 17 cytokines and chemokines in aqueous humor specimens obtained from patients with ocular toxoplasmosis or viral uveitis and compared these concentrations with those in specimens obtained from patients with noninfectious intermediate uveitis or cataract. RESULTS: Five mediators (interleukin [IL]-8, monocyte chemoattractant protein-1, tumor necrosis factor-alpha, IL-4, and IL-10) were detected in >50% of patients in all groups. In contrast, IL-5 and IL-12 were specific for ocular toxoplasmosis, and granulocyte monocyte colony-stimulating factor and IL-1 were specific for viral uveitis; these mediators could present specific markers for diagnostic purposes. Interferon-gamma, IL-6, and macrophage inflammatory protein-1beta were common markers of ocular toxoplasmosis and viral uveitis. IL-17 was a common marker of ocular toxoplasmosis and intermediate uveitis. CONCLUSIONS: We found specific cytokine profiles for each type of uveitis, with large interindividual variations and no etiological or clinical correlations. Ocular cytokine mapping contributes to a better understanding of the physiopathology of specific forms of uveitis and provides guidance for new targeted treatment.