Association of PTPN22 gene functional variants with development of pulmonary tuberculosis in Moroccan population.

Mycobacterium tuberculosis, the causal agent of pulmonary tuberculosis (TB), remains a major health problem throughout the world causing high mortality in humans. Previous studies showed that several genes may play crucial roles in susceptibility to TB. The PTPN22 gene encodes the lymphoid tyrosine phosphatase that has an important regulatory effect on T- and B-cell activation in immune response. The purpose of this study was to investigate the role of two functional missense single nucleotide polymorphisms (SNPs) of the PTPN22 gene region (R620W and R263Q) in the susceptibility to TB in the Moroccan population. A case-control association study was performed including 123 pulmonary TB patients and 155 healthy controls. All subjects were genotyped by TaqMan SNP genotyping assays. Regarding the PTPN22 R620W (C1858T) SNP, we observed a statistically significant difference in the distribution of the PTPN22 1885T allele between pulmonary TB patients and healthy controls (0.41% vs 3.2%, P = 0.01, odds ratio (OR) = 0.14, 95% confidence interval (CI) = 0.01-0.93). With respect to the PTPN22 R263Q (G788A), we observed an increase of 788A allele frequencies in TB patients compared with those in healthy controls (3.65% vs 0.65%, P = 0.01, OR = 5.85, 95% CI = 1.17-39.55). These results suggest that PTPN22 gene variants may affect susceptibility to TB in the Moroccan population.

[Pseudo-Kaposi's sarcoma secondary to superficial arteriovenous malformation: Stewart-Bluefarb syndrome]. / Pseudomaladie de Kaposi secondaire à une malformation artérioveineuse superficielle: syndrome de Stewart-Bluefarb.

BACKGROUND: Pseudo-Kaposi's sarcoma or Stewart-Bluefarb subtype acroangiodermatitis is uncommon and is caused by arteriovenous fistula and malformation. We report a new case. CASE REPORT: A 33-year-old man presented with painful red-violet plaque on the dorsum of the toes with angiomatous nodules on the sole. Histological and immunohistochemical studies for CD34 were consistent with Kaposi's sarcoma. Doppler ultrasonography and femoral angiography showed multiple distal arteriovenous shunts. Free-flow embolisation with fragments of Ethibloc gelatin sponge was performed and arteriography, performed immediately afterwards, showed delayed venous drainage. The outcome was good with complete drainage of the angiomatous lesions. DISCUSSION: Pseudo-Kaposi's sarcoma Stewart-Bluefarb subtype begins early in life in male subjects, with unilateral skin lesions. It bears clinical and histological resemblance to Kaposi's sarcoma. Doppler ultrasonography and angiography show arteriovenous fistulas that classically develop at shunts, explaining the role of traumatism and high vascular pressure in the genesis of this disease.

[Adverse effects of BCG revaccination: 12 cases]. / Complications de la revaccination par le BCG: 12 observations.

INTRODUCTION: Calmette-Guérin bacillus (BCG) is a live attenuated strain used in tuberculosis vaccination. Local and systemic side-effects, although rare, are associated with BCG vaccine. They are common in cases of overdose and with poor vaccination techniques. These complications also occur in some cases of revaccination. PATIENTS AND METHODS: This was a retrospective study over a period of 5 years between January 2000 and March 2005. 12 patients presenting complications following revaccination with BCG were observed. Patients were revaccinated with BCG following a negative intradermal reaction test. The following parameters were recorded: age, gender, history, vaccination method, type of complication, treatment and outcome. RESULTS: There were 10 men and 2 and women of mean age 21 years (19 to 23 years). Mean time to consultation was 4 weeks. Complications comprised subcutaneous abscess in 8 cases, deep chronic ulcers in 4 cases complicated by humeral osteitis in one case. The dose administered was 0.1 ml in 9 patients and 1 ml in 3 others (i.e. 10 times the recommended dose). Six patients had extensive and progressive ulceration, with one positive culture, the presence of a granuloma with caseum necrosis and one case of humeral osteitis, and specific treatment was given. DISCUSSION: Revaccination is no longer recommended by the WHO since efficacy is considered to be low or even nil. Intradermal injection is the reference method for BCG vaccination. Technical errors such as injection of an excessively high dose of the vaccine or subcutaneous administration of the vaccine solution increase the incidence of adverse effects. In our study, three patients erroneously received 1 ml of vaccine and the injection was too deep in 9 cases. There are few reports in the literature concerning the underlying mechanisms of these post-revaccination accidents; two major physiopathological mechanisms, infectious and immunological, are discussed. There is no consensus regarding treatment of these complications. Six of the 12 patients received specific therapy for 6 months.

[Neurological feature of Mediterranean spotted fever: a study of four cases]. / Manifestations neurologiques de la fièvre boutonneuse méditerranéenne : à propos de quatre observations.

BACKGROUND: Rickettsia conorii is the etiologic agent of Mediterranean spotted fever that is endemic in Mediterranean. EXEGESIS: We report four cases of serious form of Mediterranean spotted fever with neurological feature. Two of them 56 and 62 years old had meningoencephalitis. Two others had cerebellitis, they are aged 43 and 56. The course has been favourable with ciprofloxacin. CONCLUSION: It is a benign well-known illness in spite of apparition of severe visceral complications, which can drag the death in 2.5% of cases. Neurological feature is more frequent and present in 28% of cases. Precocious treatment prevents this unfavourable evolution.