Brûlure oculaire sévère par projection de soude.

Chemical corneal burns are a common pathology. Those with strong bases penetrate deeply into the anterior segment and are particularly severe. We report the case of a patient suffering from corneal perforation secondary to an accidental projection of soda, and we propose to discuss the clinical and therapeutic particularities.

[Clinical features and etiologies of acute neuroretinitis in southern Tunisia]. / Profil clinique et étiologique des neurorétinites aiguës dans le sud tunisien.

INTRODUCTION: The diagnosis of neuroretinitis is clinical, with optic nerve involvement and a macular star. The most common etiology is cat scratch disease. MATERIALS AND METHODS: Study of 7 patients (7 eyes) with neuroretinitis. A complete ophthalmic examination, fluorescein angiography and optical coherence tomography were performed for all patients. A focused etiological work-up was conducted. RESULTS: The mean age of the patients was 41.6 years [27-51 years]. Decreased visual acuity was the most common reason for consultation. The neuroretinitis was unilateral in all cases. Subclinical serous retinal detachment was noted in 5 patients. The common etiologies were rickettsiosis (4 cases) and tuberculosis (1 case). Leber's idiopathic stellate neuroretinitis was concluded by the negativity of the etiological investigation. Doxycycline was the treatment of choice for rickettsiosis. CONCLUSION: Rickettsiosis appears to be more common than cat scratch disease as an etiology of neuroretinitis in the present study in southern Tunisia. Moreover, the clinical association of a serous retinal detachment, rarely reported in the literature, seems to be more frequent in our series.

Prevalence of free living amoeba in the domestic waters reservoirs in Sfax, Tunisia.

Free living amoebas (FLA) are opportunistic pathogen found in different water sources in the environment. The aim of this study was to investigate the prevalence of free living amoeba in different samples of domestic water reserves (DWR) in Sfax region from Tunisia. It was a prospective study dealing with 486 water samples collected from different DWR. After filtration through a cellulose acetate membrane samples were cultured on non-nutrient agar and the FLA were detected and strained with Giesma, Trichrome and red nuclear stain for morphological and morphotypic studies. FLA were found in 62% of samples. The Acanthopodial morphotype was detected in 43%, Polytactic (38%), Monotactic (28%), Fan-shaped (17%), Rugose (11%), Dactilopodial (10%) and Eruptive (9%). These results demonstrate that domestic water reserves are a significant source of the FLA and maintenance of DWR is recommended.

Orbital cellulitis secondary to a fungal sinusitis caused by Scopulariopsis: The first case in Tunisia.

We report a case of invasive fungal sinusitis caused by Scopulariopsis in 57 year-old man who had recurrence of orbital cellulitis. CT-scan and magnetic resonance imaging found an orbital cellulitis associated to a left frontal sinusitis with bone erosion and calcification. Patient was treated by surgical debridement and voriconazole. Culture of excised tissue was positive for Scopulariopsis.

[Ocular tuberculosis : A case series]. / La tuberculose oculaire : une série de 14 cas.

OBJECTIVES: Ocular tuberculosis is a rare form of extra pulmonary tuberculosis. It represents 1-2% of all clinical forms. The aim of this work was to focus on diagnostic and therapeutic characteristics of ocular tuberculosis. METHODS: We report a case series of 14 patients with ocular tuberculosis seen in an infectious diseases department between 2006 and 2015. The diagnosis was retained on clinical data and a positive tuberculin skin test or interferon-gamma release assay. RESULTS: The patient's mean age was 40.7±9years. The most common clinical presentation was uveitis (11 patients and 16 eyes). An extra ocular involvement was associated in three patients. The mean duration of antitubercular therapy was 10±2.5 months. Corticosteroid therapy was associated in 11 cases. The outcome was favorable in all cases. Two patients had maintained visual sequelae. CONCLUSION: Ocular tuberculosis is a rare disease but still remains a diagnostic problem. It should be considered in case of any chronic ocular symptoms, especially in endemic countries. Early management can improve the visual prognosis.

Isolation and molecular identification of Acanthamoeba spp from oasis water in Tunisia.

In the southern Tunisia Oasis, we conducted 211 water with drawals from various water traffic sites. This water is used for agriculture, swimming or various other human activities. Acanthamoeba genus was detected in 82% of collected samples. Sequencing of the amplification products with primers P892C/P892 has allowed us to detect genotypic variation with predominance of T4 genotype (51%) and presence of the genotypes T14, T5, T3, T16, T15, T10, T11, T9 and T7. They T4, T3, T5, T15, T11 and T10 genotypes have a high potential for pathogenicity and a very high degree of virulence due to their production of serine proteases and extracellular cysteine enzymes involved in tissue degradation of the host. T4 genotype was the most abundant in the environment as well as in infections caused by Acanthamoeba spp. T5 genotype was ranked second and T3 genotype was less abundant in the environment and its pathogenicity is discussed. Acanthamoeba strains with the genotypes T16, T9 and T7 were considered non pathogenic. In fact, they have been isolated only from the environment. However, for these strains, their role as a reservoir can be a real risk to human health.

[Primary neuroendocrine tumors of the breast: a retrospective study of 21 cases and literature review]. / Tumeurs neuroendocrines primitives du sein: étude rétrospective de 21 cas et revue de la littérature.

PURPOSE: The aim of the present study was to discuss the epidemiology, clinical and pathologic features, treatment, and prognosis of primary neuroendocrine carcinomas of the breast. PATIENTS AND METHODS: We report 21 cases diagnosed over a period of 12 years (1995-2011) at the university hospital of Sfax. A review of the clinical data with pathology and immunohistochemistry study was carried out for all the cases. RESULTS: The average age was 62 years (34-86 years). At the time of the diagnosis, tumours were classified T1 and T2 (16 cases), N1 (11 cases) and M1 in two cases. The histological examination has shown 13 cases of solid neuroendocrine carcinoma, six cases of large cell type and two cases of atypical carcinoid. Grade I and II SBR were found in 18 cases. Eighty-one percent of the tumours were reactive for synaptophysin; all tumours were positive for chromogranin. Thirteen (61.9%) tumours were estrogen receptor-positive and 12 (57.5%) progesterone receptor-positive. Nineteen (90.5%) tumours were negative for HER2/neu. Overall five-year survival was 72.7%. All patients had surgical treatment with modified radical mastectomy in 13 cases. Adjuvant treatment was indicated according to histopronostic elements. CONCLUSION: For primary neuroendocrine carcinoma of the breast, multivariate analysis identified three predictive factors for mortality: disease stage, histological grade and lymph node involvement.