Epidemiologie et profil de sensibilite des isolats d'hemocultures dans un centre hospitalo universitaire marocain

Introduction : L'antibiotherapie des bacteriemies est generalement empirique dans les premieres 48 heures; fondee sur les connaissances epidemiologiques prealables et sur la frequence de sensibilite aux antibiotiques des bacteries en cause. Objectif : L'objectif de cette etude est de determiner le profil epidemiologique et la sensibilite aux antibiotiques des bacteries isolees des hemocultures dans un centre hospitalo-universitaire; afin d'optimiser l'antibiotherapie probabiliste des bacteriemies en milieu hospitalier.Materiels et Methode : Il s'agit d'une etude descriptive realisee sur une periode de 18 mois; allant de janvier 2008 au juin 2009 au niveau du laboratoire de Microbiologie du CHU Mohammed VI de Marrakech. Resultats : Cent quarante six souches bacteriennes non repetitives ont ete colligees; les bacilles a gram negatif ont represente 52;7. Les especes les plus frequemment isolees etaient Staphylococcus aureus (21;3); Enterobacter cloacae (14); Acinetobacter baumannii (12;3) et Pseudomonas aeruginosa (8;9). La resistance a l'oxacilline etait de 48;3pour Staphylococcus aureus. Aucune souche resistante aux glycopeptides n'a ete trouvee chez les souches d'enterocoques et de staphylocoques isolees. Les enterobacteries etaient resistantes aux cephalosporines de troisieme generation dans 64;3des cas avec un phenotype de betalactamase a spectre elargi. La proportion de bacilles a Gram negatif non fermentaires resistants a l'imipeneme etait de 49;9. Conclusion : Une surveillance epidemiologique des bacteriemies en milieu hospitalier est necessaire pour mieux guider l'antibiotherapie probabiliste

Clinical and immunological status of a newly diagnosed HIV positive population, in Marrakech, Morocco.

OBJECTIVE: To evaluate the clinical and the immune status of newly HIV diagnosed patients, in Marrakech city and its neighboring area, in Morocco. METHODS: We performed a retrospective study on 235 patients who have been previously confirmed for HIV infection, and underwent a CD4 T cells using flow cytometry (FacsCount, Becton Dickinson®). RESULTS: The mean age of patients was 34,3 ± 8,4 years (range: 14-55), with a male predominance (sex-ratio M/F=1.4). On basis of clinical data of the patients, 62% (n=146) of them were categorized as "category C", 18.4% (n=43) as "category B", and 19.6% (n=46) as "category A" according to CDC (Center for Disease Control) HIV classification. Among all of them, 60.4% (n=142) had less than 200 CD4T cells, 26% (n=61) had between 200 and 499 CD4T cells, and only 13.6% (n=32) showed a number of CD4T cells less or equal to 500/mm(3). CONCLUSION: The results of this study reflect a significant delay in the diagnosis of HIV infected patients. Therefore, this delay may compromise timely management of HIV infected individuals and enhances propagation of the epidemic in our country. These data confirm the need for intensifying prevention efforts among high-risk population. Moreover, continuing education in HIV/AIDS among healthcare providers should be reinforced.

[Infantile visceral Leishmaniasis: epidemiological, clinical and biological characteristics. About 93 case reports in the children hospital of Rabat]. / Leishmaniose viscérale infantile : profil épidémiologique, clinique et biologique. A propos de 93 cas.

INTRODUCTION: Infantile visceral leishmaniasis (LVI) is a problem of public health in Morocco. This parasitosis rages to the state of endemic and touches the infants. OBJECTIVES: The goal of this survey is to draw up epidemiological, clinical and biologic profile of LVI in children hospitalized in the Children's Hospital of Rabat, and to prove the contribution of serology in diagnosis of this illness. MATERIAL AND METHODS: This retrospective study concerned all LVI cases gathered in the HER during 5 years (from 1997 to 2001). For every patient included in this study, the authors collected geographical origin, age, sex, clinical data (splenomegaly, fever, hepatomegaly, paleness), and biologic data (numeration formulates red chalk, speed of sedimentation, protein in blood and electrophoresis of the proteins). The myelogram results were also exploited as well as results of serology when they were realized. RESULTS: Ninety-three LVI cases were listed with an age average of 3.5+/-3 years, and a sex ratio of 1.82 (p=0.032). Patients coming from farming surroundings or semi-urban were more numerous than those from cities: 85.5% versus 14.5% (p<0.0001). Most of the patients suffered from splenomegaly, fever and paleness; anaemia was almost constant. In case of hyperprotidemy (43.5%; n=27), the albumin-globulin report was always lower than 1.2. Indirect immunofluorescence was practised among 39 patients with a positive response in 84.6% of the cases. Forty patients whose serums were analyzed by indirect hemagglutination (HAI) had all a myelogram revealing the presence of protozoon, but only 57% of them showed a positive reaction in HAI. CONCLUSIONS: These results confirm that the LVI touches children coming from underprivileged surroundings. The triad, splenomegaly, paleness and fever, is a good element of diagnostic orientation, whereas parasite revelation in bone marrow remains the best way to establish the diagnosis of this illness.

[Bipolarity correlated factors in major depression: about 155 Tunisian inpatients]. / Facteurs corrélés à la bipolarité dans les dépressions majeures: étude d'une population hospitalière tunisienne.

The distinction between the depressive troubles according to their inclusion in bipolar disorders or in recurrent depressive disorders offers an evident practical interest. In fact, the curative and mainly the preventive treatment of these troubles are different. So it is necessary to identify the predictive factors of bipolar development in case of inaugural depressive episode. In 1983, Akiskal was the first who identified those factors: pharmacological hypomania, puerperal depression, onset at early age (<25 years), presence of psychotic characteristics, hypersomnia and psychomotor inhibition. Through this study, the authors try to compare the epidemiological, clinical and evolution characteristics of major depression in bipolar disorders to recurrent depressive disorders in order to indicate the correlated factors with bipolarity. It is a retrospective and comparative study based on about 155 inpatients for major depressive episode during the period between January 1994 and December 1998. These patients were divided into two groups according the DSM IV criteria: bipolar group (96 patients) and recurrent depressive group (59 patients). Both groups were compared according to socio-demographic data, life events in childhood, personal and family history, clinical and evolution characteristics of the index depressive episode. The predictive factors proposed by Akiskal were systematically examined. It was found out that the following factors were correlated with bipolarity: high rate of separation and divorce (17.7% versus 5.1%; p=0.02), family history of psychiatric disorders (56.3% versus 35.6%; p=0.012) especially bipolar ones (29.2% versus 3.4%; p=0,00008), onset at early age (mean age of onset: 24.8 8.2 years versus 34.1 12.6 years; p=0.000004), number of affective episode significantly more frequent (mean 3.6 versus 2.5; p=0.03), sudden onset of depressive episode (44.8% versus 15.9%; p=0.0003) and presence of psychotic characteristics (69.8% versus 16.7%; p=0.0001) catatonic characteristics (37.3% versus 20.3%; p=0.03), hypersomnia (51% versus 20.3%; p=0.03) and psychomotor inhibition (83.3% versus 42.4%; p=0.00007). Negatively correlated factors of bipolar depression were: somatic comorbidity such as diabetes, hypertension and rhumatismal diseases (12.5% versus 28.8%; p=0.012) and association with dysthymic disorders (2.2% versus 12.1%; p=0.029). No correlation was found between bipolarity and life events in childhood, seasonal character, alcoholic dependence and suicide attempt. Concerning the validity of predictive factors of bipolarity proposed by Akiskal, we found: history of bipolar disorders (Sensibility: 29.2%, specificity: 96.6%, Positive Predictive Value (PPV): 93%), hypersomnia (Sensibility: 51%, specificity: 80%, PPV: 80%), onset before the age of 25 years (Sensibility: 62.5%, specificity: 70%, PPV: 77%), psychomotor inhibition (Sensibility: 83.3%, specificity 58%, PPV: 76%), and psychotic characteristics (Sensibility: 69.8%, specificity: 62.7%, PPV: 75%). In spite of methodological differences, our results tallied with the other studies. We focus on the importance of the bipolar family history criterion, which has the highest PPV, and the limits of psychotic characteristics criterion which has the lowest PPV. This may be explained by the frequency of these characteristics of affective disorders in our cultural context. The association of the hypersomnia and psychomotor inhibition in one criterion in order to increase their diagnostic power. Our study helps us to identify the factors that would predict the bipolar evolution of a depressive episode allowing the use of specific treatment and ensuring the improvement of prognostic.