[Epidemiological and clinical features of cutaneous leishmaniasis in Kairouan-Tunisia and characteristics in children]. / Aspects épidémiologiques et cliniques de la leishmaniose cutanée à Kairouan-Tunisie et particularités chez l'enfant.

Cutaneous leishmaniasis (CL) remains highly endemic in Tunisia. The governorate of Kairouan (Center) is one of the most affected particularly by zoonotic form due to Leishmania major. The purpose of this study was to describe the epidemiological, clinical and therapeutic features of the disease in this governorate and to identify any particularities in children. Three hundred and ninety cases were registered over 2 years (2012 and 2013). The average age was 29 years one month [± 22.7] (34.6% of patients were under 15 years). The cumulative incidence of CL was equal to 34.4 per 100,000 per year. It was higher in children (39.6 per 100,000 versus 29, p=0.004). Cases were diagnosed especially in autumn and winter (88.3% of cases between October and January, p<0.001). The average delay of consultation was one month and 22 days [± 2.5] after onset of lesions. The average number of lesions per patient was 2.7 [± 2.3] with a mean diameter equal to 2.2 cm. In addition to a higher incidence of the disease, two other features were found in "Children" group which are the presence of similar cases in the neighborhood (27.7% versus 13.4%, p=0.002) and preferential localization in the face (36.4% versus 11%) while the members were more affected in adults (63.5% versus 46.4%) (p<0.001). Meglumine antimoniate was prescribed for most of our patients (93.1%). The intramuscular route was used more than local one, probably because of high proportions of multiple lesions and facial localization.

[Investigation and analysis of an outbreak of cutaneous leishmaniasis in Ksar Ouled Dabbab, Tataouine (Tunisia), 2012-2013]. / Investigation et analyse d'une épidémie de leishmaniose cutanée à Ksar Ouled Dabbab, Tataouine (Tunisie), 2012-2013.

UNLABELLED: Zoonotic cutaneous leishmaniasis (ZCL), due to Leishmania major, and chronic CL, due to L. tropica, are endemic in the governorate (administrative subdivision) of Tataouine (southeast Tunisia). This study aims to analyze epidemiologic, clinical, parasitologic, and entomologic data collected during the 2012-2013 epidemic in Ksar Ouled Dabbab (KOD). METHODS: The KOD health care center diagnosed 164 CL cases from July 2012 to March 2013, identifying 21 Leishmania isolates and local sandflies. RESULTS: The incidence rate of CL in KOD was around 27.5/1000 inhabitants. The age groups most strongly affected were children younger than 10 years (19.9%) and those aged 10-20 years (23.1%). The number of patients with multiple lesions (67.9%) and their location on limbs (71.3%) indicated ZCL. This hypothesis is supported by the high proportions of L. major (81%) and Phlebotomus papatasi found. CONCLUSION: The epidemiologic and clinical profiles of the cases and the predominance of L. major and P. papatasi confirm that the recent outbreak in KOD was related to ZCL. It probably followed recent environmental changes and transmission spread from adjacent neighboring foci.

[Evaluation and contribution of OptiMAL-IT® test for the diagnosis of imported malaria in Tunisia]. / Évaluation et apport du test OptiMAL-IT® dans le diagnostic du paludisme d'importation en Tunisie.

The rapid test OptiMAL-IT® was evaluated in the diagnosis and the screening of imported malaria in Tunisia in comparison with microscopic techniques. This prospective study focused on 500 individuals recruited from September 2010 to September 2012 in laboratory of Parasitology of Pasteur Institute of Tunis. They include 192 patients with clinical manifestations suggestive of malaria and 308 students originating from endemic areas. Microscopy of thick-and-thin blood smears and OptiMAL-IT® test were systematically performed on blood samples of all participants. Sixty individuals revealed infected by Plasmodium (12%). Positivity rates were respectively 20.3% in patients (44 cases) and 5.2% among asymptomatic students (16 cases) (p<0.01). The sensitivity and specificity of the OptiMAL-IT® test were respectively 88.6% and 100%. The concordance kappa was 0.92. The sensitivity and specificity during the screening of asymptomatic subjects were respectively 68.8% and 98.3% with a concordance of 0.67.

The course and prognosis of pemphigus in 47 Tunisian patients.

BACKGROUND: Pemphigus is a severe and life-threatening autoimmune bullous dermatosis. OBJECTIVE: We have analysed parameters that may influence prognosis of pemphigus (P). METHODS: It was a retrospective study (2002-2010), with pemphigus considered as severe if body surface involvement ≥ 30%. Disease control and relapse-free survival (Kaplan-Meier) were analysed and compared according to several parameters (P < 0.05). RESULTS: 47 cases of pemphigus were collected, mean age 51 years ± 16.8 (F/H = 3.27). There were 30 pemphigus profundus and 17 superficial pemphigus. The median remission period was of 9 months (1.2 months-5 years). The mean healing time was of 40 days (6 days-4 months), which did not depend on type of P, its severity or infectious complications, whereas it was shorter in aged patient (≥ 65 years) compared to non aged ones (P = 0.018). 36.2% of patients had relapsed. Relapses were significantly more frequently observed only in the presence of mucosal involvement at presentation (P = 0.015). The median overall 1st relapse-free survival was of 2.33 years. Only mucosal involvement at presentation was associated with a shorter median 1st relapse-free survival time (1.28 years vs. 3 years) (P = 0.0017). Mortality rate was of 10.6% (n = 5); in four patients the death was directly related to pemphigus and occurred rapidly after the onset of lesions. CONCLUSION: Our study illustrates the poor prognosis of pemphigus by a long duration to disease control, a high initial dose of oral steroid, a high rate of relapse and a short remission period. Only mucosal involvement at presentation was identified as a poor prognostic factor.

[The intestinal parasites in the food handlers of Tunis area: study of 8502 stool samples (1998-2008)]. / Les parasites intestinaux chez les manipulateurs de denrees alimentaires de la Region de Tunis: etude de 8502 prelevements de selles (1998-2008).

The food handlers control is one of the major measures of the National program against intestinal parasitoses in Tunisia. The collected data allow regular updates of the prevalence and profile of the involved parasitic species and note possible evolutions in time. From 1998 to 2008, 8502 stool samples of food handlers working in Tunis area were examined in the laboratory of Parasitology, Pasteur Institute of Tunis. The mean prevalence of intestinal parasites was 13.5% (1152 positive samples). The protozoa were the most detected parasites (93% of the species observed). Among the pathogenic or potentially pathogenic parasites, Dientamoeba fragilis (15.5%) and Giardia intestinalis (7.6%) were the most frequently encountered. Entamoeba (E.) histolytica/dispar was diagnosed in 41 subjects (a prevalence of 05%). Hymenolepis nana was the most frequent helminth (45% of the whole parasites). Therapeutic failures were noticed in 43.8% of infection by this cestode because of the lack of the appropriate antihelminthic. The identification using PCR of cysts and/or vegetative forms of E. histolytica/dispar revealed the exclusive presence of E. dispar.

[Relationship between temperature and mortality in the city of Tunis: 2005-2007]. / Relation temperature-mortalite pour la ville de Tunis: 2005-2007.

The influence of thermal stress on health is proved. In the light of the current climate change this relationship should be extensively investigated. This study aims to describe the relationship between temperature and total mortality in the city of Tunis over a period of three years, from 2005 to 2007 using time series analysis. The form of the relation (crude and adjusted) between mortality and temperatures was investigated using Poisson generalized additive models (GAM). Confounders included in the models were pollutant, trend, calendar month, day of the week, the period of Ramadan, and holidays. The adjusted relationship between mortality and temperature was "V" shaped with a steeper slope for low temperatures than for high temperatures. The impact of heat on mortality will be further analyzed to refine our findings and to contribute to the elaboration of guidelines for preventive strategies.

Quantitative detection of bcr-abl transcripts in chronic myeloid leukemia.

The optimal management of malignant haematological disorders depend on the degree of tumor load reduction after therapy. Chronic myeloid leukemia constitutes a clinical model for molecular detection and therapy surveillance of malignant disease since this entity was the first leukemia shown to be associated with a specific bcr-abl fusion gene in the patient's leukemia cells. Molecular monitoring of bcr-abl transcript levels by real-time quantitative PCR is increasingly used to assess treatment response in patients with chronic myeloid leukemia (CML). This has become particularly relevant in the era of imatinib therapy when residual levels of leukaemia usually fall below the level of detection by bone marrow cytogenetic analysis. We monitored bcr-abl transcript levels by quantitative real time PCR in 50 tunisian patients treated with imatinib for chronic myeloid leukemia in chronic phase for a median of 29 months (3-60) after they started imatinib.

Donnees epidemiologiques; cliniques et parasitologiques actualisees de la leishmaniose cutanee en Tunisie

Afin d'actualiser la repartition geographique des 3 formes noso-geographiques de leishmaniose cutanee (LC) endemiques en Tunisie; la zoonotique (LCZ); la sporadique(LCS) et la chronique (LCC); et d'en rappeler certaines caracteristiques epidemiocliniques;une etude a concerne 244 cas de la maladie. La majorite des patients ont ete contamines au Centre et au Sud du pays (74;2) et correspondent a des cas de LCZ (64;8). Les 3 formes ont ete enregistres dans des regions considerees jusqu la indemnes traduisant leur extension geographique. Les 2 sexes ont ete egalement touches (sexe ratio=1;02). L'age moyen etait de 24;6 ans avec predominance d'enfants et d'adultes jeunes les lesions de LCZ etaient souvent multiples (54;1) et localisees aux membres (81;5) et celles de LCS plutot uniques (91; p0;001) touchant le visage (84;3; p0;001). Une orrelation negative a ete notee entre le nombre de lesions et leur anciennete (r) et celui en plaques erythemateuses infiltrees celles de LCS (55;9); p=0;002. Leishmania (L.) major se confirme l'espece la plus frequente (60;9). Au sein du complexe L. infantum (27;6); le zymodeme MON-24 a ete le plus identifie. L. killicki a represente 11;3des isolats. L'emergente de la LC se maintient en Tunisie avec une incidence elevee et une extension de la distribution geographique. Les changements environnementaux; a l'origine de bouleversements de la repartition et de la densite des phlebotomes vecteurs et des reservoirs respectifs; en seraient les principales cause

[Seroprevalences of hepatitis A and E infections in Tunisia]. / Séroprévalences des infections à hépatite A et E en Tunisie.

OBJECTIVE: Viral hepatitis A (HAV) and E (HEV) infections are still frequent in many regions of the world, particularly in developing countries where sanitary conditions and socioeconomic level are frequently low. In this work, we have studied seroprevalences of these two infections in Tunisian children, teenagers and young adults. MATERIAL AND METHODS: The studied population included 3357 individuals from different regions of Tunisia and distributed in three groups 1 (n=1145), 2 (n=707) and 3 (n=1505) with a mean of age of 6.94, 12.84 and 20.71 years, respectively. RESULTS: Rates of HAV infection prevalence of 84.0, 90.5 and 91.7% were found within groups 1, 2 and 3, respectively. These rates are lower than those previously found in the country; thus, primary infection with HAV in Tunisia is progressively shifting to older ages, which is probably due to the improvement of sanitary conditions. Lower anti-HAV prevalences were found in costal regions as compared to the rest of the country. This difference may be due to the higher socioeconomic level of the population living in costal regions. Antibodies against HEV were assessed in individuals of group 3. A seroprevalence of 4.3% was found which indicates that, despite the absence of epidemics, the virus is circulating among the Tunisian population as sporadic cases. CONCLUSION: The present work contributes to a better knowledge of HAV and HEV infections in Tunisia and highlights the need of the establishment of a national program for virological surveillance of hepatitis cases and of further studies to monitor changes in the epidemiology of these infections.

[Health indicators in Tunisia, trends in regional disparities over the last thirty years]. / Indicateurs de sante en tunisie, evolution des disparites inter-regionales au cours des trente dernieres annees.

The measure of health indicators on a regional-scale seems more interesting then the measure on a national-scale. It allows us to study differences between regions and their evolution. In order to know the time trend's disparities between regions, we have studied seven indicators, concerning different types of the World Health Organisation's classification, using data from yearly statistics and results of decennial census. Regional disparities are evaluated by a ratio between the highest regional value and the lowest regional value. This study showed us a global trend to the decline of regional disparities about indicators that we have studied. The improvement of health care resources indicators and socioeconomic's indicators, in the process of time, is associated with the improvement of health status indicators. The study of regional disparities makes possible to target actions for health in order to promote health's equity between regions.

[Certification of cause of death in Tunisia]. / Declaration des causes de deces en Tunisie.

We have led a study about 2251 death witch are declared during 1996 in the Great-Tunis. Results are following: The hospital deaths are as many betters certified that the physician is a specialist. The cause mention rate is about 88.6% for death observed by specialists against 28.5% for those observed by internists. Paradoxically, a precise cause mention is best for deaths that are observed outside hospitals and when the physician is an internist. Badly define morbid states represent 17.1% of outside hospitals mentioned causes against 30.8% in the Hospital. They represent 12% of causes mentioned by internist against 30.1% of those mentioned by specialists. Despite death medical certificate obligation, the strong proportion of badly defined morbid states characterizes death causes. We hope that this situation will be improved by the new model usage of the witch will be introduced since 2000. This certificate mentions death causes distinguished in initial, immediate and associated. This certificate has be the object of the decree n degree 99-1043 of 17 may 1999.

[Study of the incidence and cost of nosocomial infections in general surgery]. / Etude de l'incidence et approche du surcout des infections nosocomiales en chirurgie generale.

Nosocomial infection incidence and its cost were study. We have identified 61 infected patients and 75 infectious episodes, is an incidence of 9.4% infected for 100 hospitalized by trimester. Operative site infections are the most frequent (60%), operative site infection (9.1%), inferior respiratory ways infections (2.2%). Incriminated germs are represented essentially by negative gram Bacillus (77.3%) with predominance of enterobacterias (59%). Invasive technique usage, surgery types and contamination classes have been identified as risk factors of nosocomial infection occurrence. The supplementary stay duration estimated by simple comparison between infected group and no-infected one is 9.3% days, responsible of an over cost of 336 TD by infected patient and 273 TD by infectious episode. The curative antibiotic costs have been estimated at 70 TD by infected patient being equivalent to two hospitalization days and to 57 TD by infectious episode.