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.

[Evaluating the therapeutic care of HIV infection in Tunisia]. / Evaluation de la prise en charge thérapeutique de l'infection par le VIH en Tunisie.

OBJECTIVE: Our aim is to determine different therapeutic response profiles in Tunisian HIV-1 infected patients, to identify those with therapeutic failure and to compare the results of the genotypic resistance test used in Tunisia (INNO LiPA Test) with those of automatic sequencing to evaluate its efficacy. METHODS: The retrospective survey concerns 392 infected patients enrolled from January 2001 to December 2006. Evaluation of HIV INNO LiPA test was performed by comparing these test results with those of automatic sequencing in 36 plasmatic samples for 13 infected patients with therapeutic failure. RESULTS: on the basis of the HIV viral load evolution, 57.55% of patients present a good therapeutic response and 42.44% a bad one. Patients with therapeutic failure require genotypic resistance test. A comparison of HIV INNO LiPA test and direct sequencing showed a strong concordance between the two tests results either for reverse transcriptase gene or protease gene. However, the results obtained by INNO LiPA test (8.79% of analysed codons ) and the limited number of analysed codons were the defaults of INNO LiPA technique. CONCLUSION: the contribution of INNO LiPA technique in the knowledge of the epidemiological HIV resistance profiles of virus strains of HIV infected individuals failing therapy was considerable. However, due to INNO LiPA technique limitations, sequence analysis must be considered a more complete assay for the monitoring of antiretroviral resistance of HIV infected patients.

MEFV mutations in Tunisian patients suffering from familial Mediterranean fever.

OBJECTIVES: To identify the frequency and distribution of familial Mediterranean fever (FMF) gene (MEFV) mutations in Tunisian patients. PATIENTS AND METHODS: This study was performed in the Genetic Department of Tunis University Hospital. A clinical diagnosis of FMF was made according to published criteria. Mutation screening of the MEFV gene was performed in the Human Genetic Laboratory of the "Faculté de Medecine de Tunis" for 8 mutations including the 5 most common known mutations M694V, V726A, M694l, M680l, and E148Q. The tests performed were polymerase chain reaction (PCR) restriction-digestion for M694V, V726A, M680l, R761H, E148Q; amplification refractory mutation system for A744S, M694l; and PCR-electrophoresis assay for l692del. RESULTS: Of the 139 unrelated patients investigated, 61 (44%) had 1 or 2 mutations. In 78 (56%) probands no mutation was identified: 28 patients were homozygous; 16 were compound-heterozygous; 2 had complex alleles; and 17 had only 1 identifiable mutation. Of the mutations, M680l, M694V, M694l, V726A, A744S, R761H, l692DEL, and E148Q accounted for 32, 27, 13, 5, 3, 1, 1, and 18%, respectively. CONCLUSION: The profile of the MEFV gene mutations in the Tunisian population is concordant with other Arab populations but with some differences. M680l is the most common mutation, while V726A, the commonest mutation among Arabs, is rare in our population.

Epidemiology of infective endocarditis in Tunisia: a 10-year multicenter retrospective study.

BACKGROUND: Since the first description of infective endocarditis, the profile of the disease has evolved continuously with stable incidence. However, epidemiological features are different in developing countries compared with western countries. OBJECTIVE: To describe epidemiological, microbiological and outcome characteristics of infective endocarditis in Tunisia. PATIENTS AND METHODS: This was a descriptive multicenter retrospective study of inpatients treated for infective endocarditis from 1991 to 2000. Charts of patients with possible or definite infective endocarditis according to the Duke criteria were included in the study. RESULTS: Four hundred and forty episodes of infective endocarditis among 435 patients (242 males, 193 females; mean (SD) age=32.4 (16.8) years, range 1-78 years) were reviewed. The most common predisposing heart disease was rheumatic valvular disease (45.2%). Infective endocarditis occurred on prosthetic valves in 17.3% of cases. Causative microorganisms were identified in 50.2% of cases: streptococci (17.3%), enterococci (3.9%), staphylococci (17.9%), and other pathogens (11.1%). Blood cultures were negative in 53.6% and no microorganism was identified in 49.8%. Early valve surgery was performed in 51.2% of patients. The in-hospital mortality was 20.6%. CONCLUSION: Infective endocarditis is still frequently associated with rheumatic disease among young adults in Tunisia, with a high frequency of negative blood cultures and high in-hospital mortality, given that the population affected is relatively young.

[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.

[Association of systemic lupus erythematosus and dermatopolymyositis]. / Association d'un lupus erythémateux systémique et d'une dermatomyosite.

Systemic lupus erythematosus (SLE) associated with dermatopolymyositis (DM). This association is rare. Diagnosis may be difficult because of their common clinical findings. We report here a case. A 22-year-old man was admitted for arthritis with fever, diffuse myalgia and periorbital skin heliotrope rash. Electromyogram and muscular biopsy were suggestive of DM. The patient was treated with oral prednisone. Two months and a half later, he was admitted for impure nephrotic syndrome in relation with diffuse proliferative glomerulonephritis. Antibodies against native double-stranded- DNA were positive, and normal skin biopsy showed immune complex deposit on dermo-epidermic junction, suggestive of SLE. The patient was treated with high doses of prednisone and 6 monthly intravenous pulses of cyclophosphamide. Skin lesions and nephrotic syndrome improved. Presently, the patient remains asymptomatic. While being of different pathogenesis, SLE and DM may coexist in the same patient.

[Efficacy of doxycycline in thoracic actinomycosis: a case report]. / Efficacite de la doxycycline dans l'actinomycose thoracique: a propos d'une observation.

The authors present a case of thoracic actinomycosis in a 32 year-old man with a history of cervico-facial actinomycosis. Diagnosis was made by bacterial examination of purulent drainage from sternal wound showing typical sulfures granules. One year course of doxycycline gives clinical and radiological improvement.

[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.

[Articular manifestations of adult Still's disease]. / Les manifestations osteoarticulaires dans la maladie de Still de l'adulte.

Adult onset Still's disease is a rare systemic disorder of unknown etiology occuring in young adults. The diagnosis is difficult and based upon Yamaguchi's criteria after exclusion of infectious diseases, hemotologic process or autoimmune diseases. Clinical manifestations are various. Functional prognosis depends essentially on articular involvement. We report a retrospective and multicenter study of 26 cases of adult still's disease collected during 10 years. Arthralgia are constant and arthritis are observed in third of the cases. Radiologic joint alterations are found in five cases. A literature review was done with emphasis on clinical and radiological characteristics of articular manifestations.

[Frequency of Pneumocystis carinii pneumonia in HIV-infected patients in Tunisia]. / Frequence des pneumopathies a Pneumocystis carinii chez le sujet infecte par vih en Tunisie.

In Tunisia, as in most african countries, Pneumocystis carinii pneumonia (PCP) is considered to be rare in HIV-infected patients. Frequencies of 8.6% and 21% have been reported. We examined 27 broncho-alveolar lavage specimens collected from HIV-infected tunisian individuals with respiratory symptoms over 4 years (1994-1997), by cyto centrifugation, Giemsa and Gomori-Grocott stain. Pneumocystis carinii (P carinii) was present in 9 cases, accounting for 33.3% of all specimens. Investigation of the reasons for the differences between african reports is necessary to establish appropriate therapeutic management. Technical difficulties of direct recognition of P carinii and selection bias may account for differences between african reports. However, differences still remain between the frequencies recorded in Africa and in other parts of the world, and recent advances seems to correlate this with geographical biodiversity of human-derived strains of P carinii and with differences in host ethnic background.

[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.

[Bronchopulmonary aspergillosis: study of 17 cases]. / L'aspergillose broncho-pulmonaire: etude de 17 cas.

Aspergillosis is a fungic infection depending on the local or general physiologic and immunologic state of the host. We report the result of retrospective five year study (1995-1999) about 17 cases in the laboratory of Parasitology-Mycology of Rabta hospital in Tunis. Six aspergillomas were observed, they occurred after a pulmonary tuberculosis, two cases of allergic broncho-pulmonary aspergillosis described in two asthmatic patients, nine cases of invasive pulmonary aspergillosis complicating two cancers, one leukaemia, six chronic granulomatous disease. Aspergillus fumigatus is the most frequent species (67%). The clinical and biological characteristic of those will be studied, and compared with those of the literature.