[Silicoproteinosis: a specific clinical and radiological entity]. / La silicoprotéinose : une entité radioclinique à part.

INTRODUCTION: Silicoproteinosis is a rare disease, which can cause the rapid onset of respiratory failure following massive exposure to silica dust. CASE REPORT: A 25-year-old patient presented with altered state and dyspnea. The diagnosis of military pulmonary tuberculosis was first considered and antituberculous treatment was started. The diagnosis was reconsidered due to a lack of improvement and the discovery of an 18-month history of exposure to silica. The patient had stopped work 6 months prior to hospitalization. High-resolution CT showed air space condensation associated to centrilobular nodules throughout the lungs and multiple mediastinal lymph nodes, suggesting sarcoidosis. Bronchoalveolar lavage (BAL) suggested the diagnosis of lipoproteinosis. Because of discordance between the bacteriological, radiological and the BAL results, a surgical lung biopsy was performed which led to the diagnoses of a secondary lipoproteinosis. The diagnosis of silicoproteinosis was then considered. Over a one-year follow up, the patient's respiratory failure has progressed markedly despite treatment with corticosteroids. CONCLUSION: Silicoproteinosis is a distinct pathological entity, the diagnosis of which depends on clinical and radiological features as well as BAL findings, which may avoid the need for more invasive investigations.

[Role of cryptosporidia and microsporidia in diarrhea in immunocompromised patients]. / Place des cryptosporidies et des microsporidies dans les diarrhees des immunodeprimes.

Cryptosporidium and Microsporidian play an important part in the diarrhoeic pathology of the immunocompromised patients. The study of 35 cases of cryptosporidiosis and 4 cases of intestinal microsporidiosis diagnosed in the parasitology laboratory of Rabta hospital of Tunis shows that cryptosporidiosis prevalence is 17.24% for AIDS patients, 3.45% for immunocompromised patients VIH (-), and microsporidiosis prevalence is 5.7% for patients with acquired immunodeficiency syndrome. Common points for these two parasitosis are: Clinical syndromes dominated by an acute diarrhea A diagnosis based on specific techniques showing the significance of the clinical orientation. Lack of an effective specific therapy.

[Standard radiological characteristics of thoracic sites of tuberculosis in patients with AIDS in a Tunisian population]. / Particularités radiologiques standards des localisations thoraciques de la tuberculose chez des sidéens dans une population Tunisienne.

Aspects of tuberculosis on the standard chest X-ray in a population of 18 AIDS patients in Tunisia were examined. The diagnosis of pulmonary tuberculosis was confirmed in all cases with bacteriology tests. Diffuse lesions of the parenchyma predominated contrasting with the exceptional nature of cavernous formations. Localized infiltrations were infrequent and intrathoracic node enlagement was rare. Cases with no abnormal radiological signs were also seen in advanced HIV infection. Such atypical cases, in agreement with data in the literature, would be explained by immunoradiologic correlation. Thus it is necessary to search for the tuberculosis bacilli in all patients with HIV infection whatever the aspect on the standard chest X-ray.

PIP: The chest X-ray is a fundamental element in the diagnosis of pulmonary tuberculosis (TB). In the person co-infected with HIV and TB, radiological signs can be deceiving given the degree of immunodepression and the resulting clinical manifestations. TB is endemic in Tunisia with a prevalence of 120 people infected per 100,000 population. TB affects 42% of people with AIDS in Tunisia, the major opportunistic infection in that population. The authors report upon their examination of aspects of TB in the standard chest X-ray of 18 AIDS patients in Tunisia. The diagnosis of pulmonary TB was confirmed in all cases with bacteriology tests. Diffuse lesions of the parenchyma predominated contrasting with the exceptional nature of cavernous formations. Localized infiltrations were infrequent and intrathoracic node enlargement was rare. Cases with no abnormal radiological signs were also seen in advanced HIV infection. Such atypical cases, in agreement with data in the literature, could be explained by immunoradiologic correlation. The authors stress the need to search for the TB bacilli in all patients with HIV infection regardless of the aspect on the standard chest X-ray.

[Non-surgical treatment of kidney abscesses. Apropos of 12 cases]. / Le traitement non chirurgical des abcès du rein. A propos de 12 cas.

Twelve renal abscesses were treated with percutaneous aspiration (6 patients), percutaneous drainage (3 patients) or antibiotics alone (3 patients). The diagnosis was established based on computed tomography-guided aspiration in 9 cases and on radiographic findings and follow-up in the remaining 3. A bacterium was isolated in 2 out of 9 blood cultures, 2 out of 11 urine cultures and in all cultures of pus obtained by percutaneous aspiration. All patients had a good outcome. Our findings confirm the efficacy of percutaneous aspiration in the treatment of renal abscesses. Percutaneous drainage should only be considered when the abscess is very large or aspiration has failed.

[Characterization and evolution of blood cryoglobulin in visceral leishmaniasis]. / Caractérisation et évolution d'une cryoglobulinémie au cours d'une leishmaniose viscérale.

The evolution of immunological parameters in mediterranean visceral leishmaniasis reveal a type III mixed cryoglobulin with rhumatoid factor activity and antileishmania antibodies. This cryoglobulin follows the clinical signs of the disease and disappear under treatment. The authors insist on the transitory character of this cryoglobulin which is in relation with polyclonal stimulation of the immune system by parasitical infection.