[DROSOPHILA MELANOGASTER GASTROINTESTINAL MYIASIS: ABOUT A MOROCCAN CASE REPORT]. / MYIASE GASTRO-INTESTINALE À DROSOPHILA MELANOGASTER : À PROPOS D'UN CAS MAROCAIN.

Introduction: Myiasis is an infestation of humans or animals by larval forms of brachycetes. Commonly observed locations are otolaryngological and cutaneous. Gastrointestinal localization remains exceptional. In this work, we report the observation of a Moroccan case of gastrointestinal myiasis caused by Drosophila melanogaster. Observation. The patient was a 56-year-old man living in a rural region of northwest Morocco. He was being followed at the National Oncology Institute in Rabat for pulmonary and renal adenocarcinoma and was put on neo-adjuvant chemotherapy with concomitant radiochemotherapy. The patient presented vomiting twice containing about forty small white, circular and hairless worms measuring 4 mm in length. This sample was sent to the parasitology and mycology laboratory for identification. Microscopic study of the larvae and adult flies obtained after rearing in the laboratory of parasitology allowed the diagnosis of myiasis caused by Drosophila melanogaster. Discussion/Conclusion: This observation is noteworthy for both its exceptional anatomical localization and the implicated parasite species.

[Hydatidosis of psoas muscle revealed by vascular axis compression in lower limb: About one case at the Ibn Sina University hospital, Rabat, Morocco]. / Hydatidose du muscle psoas révélée par une compression de l'axe vasculaire du membre inférieur : À propos d'un cas au Centre hospitalier universitaire Ibn Sina, Rabat, Maroc.

Introduction: Hydatidosis is a zoonosis caused by Echinococcus granulosus. It's a real public health problem in Morocco. Muscle localization is unusual, even in endemic countries. We report a rarely described case of a hydatid cyst of the psoas muscle diagnosed in our laboratory. Case report: The patient was a 32-year-old male, living in a rural area. He reported a contact with dogs. He was admitted in vascular surgery department for left hypochondrium pain, with heaviness of the left lower limb and appearance of varicose veins. Clinical examination has found a huge painful and hard mass of the left flank arriving to the hypogastrium with varicose veins of the left leg. An injected CT scan of the pelvic region showed a 189 x 137 mm cystic mass of the left psoas muscle reflowing left iliac vessels. This suggested hydatid cyst. No other localization was found. Hydatid serology was positive with an ELISA test and an indirect hemagglutination test. The patient underwent surgery to remove the mass. Several white vesicles of a few centimeters were found in the cyst and were sent to the parasitology laboratory. Microscopic examination has confirmed the presence of viable Echinococcus granulosus. The patient received albendazole 400 mg twice daily for only a month and was not seen for follow-up. One year after surgery, he showed the same symptoms of abdominal pain and heaviness. Recurrence of hydatid cysts in the same localization was diagnosed with ultrasound showing two hydatid cysts type 3 according to Gharbi classification. Discussion: Diagnosis of all hydatidosis localizations is based on epidemiological, clinical, and radiological data and confirmed by serology and parasitological examination of the surgical specimen. Surgery is then a diagnostic and therapeutic tool that cannot be bypassed since it allows the definitive elimination of the parasite and eviction of recurrence if it's well done. Conservative methods are related to recurrent cysts. Conclusion: Muscle hydatidosis is extremely rare but should not be forgotten when radiological and epidemiological data suggest it. It's a benign infection but can be severe and deadly if not appropriately treated.

[Nasal myiasis due to lucilia sp. in intubated patient: about one case in Morocco]. / Myiase nasale à lucilia sp. chez un patient intubé : à propos d'un cas au Maroc.

Introduction: Myiasis is the infestation of living bodies of animals and humans with fly larvae or maggots. These accidental or obligatory parasites grow in three stages in the host while feeding on his tissues. Myiasis in a hospital area is a rare situation when flies accidentally lay their eggs on patients, mostly in open wounds or cavities. Case presentation. We report a case of a 72-year-old patient admitted to a general surgery department for peritonitis, then to an intensive care unit (ICU) for septic shock where he was intubated. Some maggots were seen moving in his nasal cavity a few days after his admission and were sent to our laboratory for examination. The larvae were identified as the third larval stage of Lucilia sp. They were removed entirely after intense nasal washing. A checking examination of his nasal cavities revealed no evidence of further infestation. After nasal washing, no other larvae were seen but unfortunately, the patient died of septic shock a few days later. Discussion: Few cases of nasal myiasis in hospitalized patients were reported. ICU myiasis, extremely rare, is caused by the patient's inability to fend off the flies because of their conscious state, presence of blood or odors caused by infections, and the warm humid environment. Conclusion: Myiasis in intensive care unit is a delicate situation that might be underreported. Preventing this infection is directly related to the control of the flies.

[Forty cases of neuromeningeal cryptococcosis diagnosed at the Mycology-Parasitology Department of the Ibn Sina hospital in Rabat, over a 21-year period]. / Quarante cas de cryptococcose neuroméningée diagnostiqués en 21 ans au laboratoire de parasitologie de l'hôpital Ibn Sina de Rabat.

Neuromeningeal cryptococcosis is a common and severe opportunistic fungal infection caused by the encapsulated yeast Cryptococcus neoformans. It commonly occurs in immunocompromised patients, in particular in subjects with advanced stage HIV while it is rare in immunocompetent patients. We report 40 cases of neuromeningeal cryptococcosis (NMC) diagnosed at the Mycology-Parasitology Department of the Ibn Sina hospital in Rabat, over a 21-year period (1993-2014). The diagnosis was based on nested-PCR-based assay for the detection of Cryptococcus neoformans after staining with China ink and culture on Sabouraud agar without actidione as well as on the identification of soluble cryptococcal antigens. Thirty-five patients had HIV infection, 2 patients were apparently immunocompetent and 3 were immunocompromised patients without HIV (30 men and 10 women). The average age of patients was 38 years; neuromeningeal cryptococcosis was indicative of HIV infection in 13 cases. In 22 cases it was a complication of AIDS. Twenty-seven patients of our series were treated with fluconazole monotherapy. Amphotericin B was used in 13 patients. Outcome was favorable in 13 patients (32.5%) while 3 patients had complications (7.5%). Eighteen patients died (45%) and 6 were lost to follow-up (15%). The tests to diagnose a Cryptococcus neoformans infection should be performed systematically in patients with neurological signs for early diagnosis.

Comparative evaluation of immunochromatographic dipstick test (ICT) rk39, soluble antigen ELISA and IFAT for the sero-diagnosis of visceral leishmaniasis in Morocco.

A rapid, sensitive and specific tool for detection of Leishmania infantum infection in Humans would be highly desirable, because it would allow control interventions in endemic areas of visceral leishmaniasis. This study was carried out at the Reference National Laboratory of Leishmaniasis (RNLL) in National Institute of Hygiene (NIH) Morocco, in order to evaluate the diagnostic potential of immunochromatographic dipstick test (ICT) rk39 in Moroccan suspected VL patients. A total of 49 admitted patients with strong clinical suspicion of VL and 40 healthy controls were investigated for the performance of the ICT rk39. Bone marrow smears were examined for microscopic detection of Leishmania amastigotes obtained from the admitted patients. Only PCR and smear positive cases were considered as gold standard as well as confirmed cases of VL. Out of 49 suspected patients, twenty four (48.9%) were found PCR and smear-positive and twenty three (46.9%) were positive for ICT rk39. Voluntary healthy controls, which included twenty persons from the endemic zone and twenty from non-endemic zone of VL, were found all negative for the strip test. The sensitivity in sera was 75% by ELISA and 87.5% by IFAT, compared with 95.8% for ICT rk39. Specificity was 95.8%, with both tests ELISA and IFAT, and 100% by ICT rk39 respectively. Present study findings again reinforce that the ICT rk39 is a simple, reliable and easy-to-perform non-invasive diagnostic tool for visceral leishmaniasis in the endemic area of Morocco.

[Epidemiological profile of echinococcosis in Morocco from 1980 to 2008]. / Profil épidémiologique de l'hydatidose au Maroc de 1980 à 2008.

The aim of this study was to analyze the epidemiology and evolution of hydatidosis in Morocco. This is a descriptive and retrospective study over a period ranging from 1980 to 2008. The patient data were collected from the epidemiological bulletin issued by the Department of Epidemiology and Fight against Disease that report all cases operated for hydatidosis between 1980 and 1992, and from the annual reports of parasitic diseases published annually by the same department between 2003 and 2008. We identified 23512 cases of hydatidosis with an annual increase in the number of cases and their incidence. Hydatidosis is present on any area of Morocco, with an uneven distribution from one region to the other. It is mostly observed in patients from rural areas and a predominance of female cases is observed throughout the period of study (sex ratio M/F = 0.66). All age groups are affected with a predominance of young adults. The liver is the organ most affected followed by the location of lung. These results show that hydatidosis remains a major public health problem in Morocco. Continuous monitoring of the epidemiological situation is essential to assess the measures implemented to fight against this infection and to allow rehabilitation and adjustment of these measures in order to reduce the incidence of this disease.