Rabies in Morocco: Epidemiological Aspects and Post-exposure Prophylaxis Management.

Background Rabies is a zoonosis transmitted accidentally to humans and is fatal once clinical signs appear. In Morocco, rabies remains a difficult disease to eradicate, with dogs being the main source of contamination. Transmission of this illness can be avoided by promptly implementing post-exposure prophylaxis (PEP) following animal exposure. Inappropriate or delayed PEP increases the risk of acute infection. This study aims to describe and analyze the characteristics of exposure, investigate the factors related to delay in initiating PEP, and evaluate the attitudes and practices of patients towards animal exposure in the region of Ouarzazate between 2016 and 2019. Methods This was a retrospective study with statistical analysis. The data on animal exposure was collected from the Anti-Rabies Center (ARC) located in Ouarzazate Province, Morocco. Results A predominance of male cases (61.3%) among victims of animal exposure was found. The age group of five to 14 years was the most affected (23.5%). The upper limb represented the most frequent site of exposure (49.4%). Around 52.1% of patients presented with multiple lesions. About 54.4% of cases were bitten by a stray animal. Dogs were responsible for 47.8% of the bites. All exposed individuals performed wound cleansing prior to arrival at the ARC. Post-exposure prophylaxis was initiated in 34.5% of cases between 24 to 48 hours, while 26.1% of cases delayed it beyond 48 hours. Around 34% of patients did not complete their vaccination schedule. Regarding the factors associated with the delay in PEP, we found significant associations with patient age, place of residence (urban or rural), distance from the ARC (>30 km or <30 km), nature, number, and injury status (p≤0.05). Significant associations (p≤0.05) were also found with dog bites and their type (domestic or stray). Conclusion Our findings indicate that better awareness about rabies and PEP management is needed, especially among the rural population.

What happened during COVID-19 in African ICUs? An observational study of pulmonary co-infections, superinfections, and mortality in Morocco.

BACKGROUND: There is a growing literature showing that critically ill COVID-19 patients have an increased risk of pulmonary co-infections and superinfections. However, studies in developing countries, especially African countries, are lacking. The objective was to describe the prevalence of bacterial co-infections and superinfections in critically ill adults with severe COVID-19 pneumonia in Morocco, the micro-organisms involved, and the impact of these infections on survival. METHODS: This retrospective study included severe COVID-19 patients admitted to the intensive care unit (ICU) between April 2020 and April 2021. The diagnosis of pulmonary co-infections and superinfections was based on the identification of pathogens from lower respiratory tract samples. Co-infection was defined as the identification of a respiratory pathogen, diagnosed concurrently with SARS-Cov2 pneumonia. Superinfections include hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). A multivariate regression analysis was performed to identify factors independently associated with mortality. RESULTS: Data from 155 patients were analyzed. The median age was 68 years [62-72] with 87% of patients being male. A large proportion of patients (68%) received antibiotics before ICU admission. Regarding ventilatory management, the majority of patients (88%) underwent non-invasive ventilation (NIV). Sixty-five patients (42%) were placed under invasive mechanical ventilation, mostly after failure of NIV. The prevalence of co-infections, HAP and VAP was respectively 4%, 12% and 40% (64 VAP/1000 ventilation days). The most isolated pathogens were Enterobacterales for HAP and Acinetobacter sp. for VAP. The proportion of extra-drug resistant (XDR) bacteria was 78% for Acinetobacter sp. and 24% for Enterobacterales. Overall ICU mortality in this cohort was 64.5%. Patients with superinfection showed a higher risk of death (OR = 6.4, 95% CI: 1.8-22; p = 0.004). CONCLUSIONS: In this single-ICU Moroccan COVID-19 cohort, bacterial co-infections were relatively uncommon. Conversely, high rates of superinfections were observed, with an increased frequency of antimicrobial resistance. Patients with superinfections showed a higher risk of death.

Bilateral tuberculous psoas abscess.

The unilateral psoas abscess is a rare disease that is often caused by common germs, including Staphylococcus aureus . Tuberculous origin and bilateral involvement are even rarer, especially in developed countries. It may be primary or secondary to a neighbourhood focus. We report a case of bilateral tuberculous abscess of psoas in an immunocompetent patient secondary to spondylodiscitis.

[Brain abscess caused by Streptococcus intermedius: a case report]. / Abcès cérébral à Streptococcus intermedius : à propos d'un cas.

Streptococcus intermedius is considered as a commensal of the oropharynx, but can be a source of serious infections. We report a case of cerebral abscess in a young man of 18 years, who was admitted to the emergency room for consciousness disorder, and whose cerebral CT showed a frontal mass evoking the diagnosis of abscess. Diagnosis was confirmed by bacteriological examination of puncture fluid which was in favor of Streptococcus intermedius abscess.

[Psoas abscess due to Candida tropicalis: a case report]. / Abcès de psoas à Candida tropicalis : à propos d'un cas.

Psoas abscess is a rare infection, difficult to diagnose, which can be primary or secondary, it is often caused by a bacterial micro-organism (Staphylococcus aureus, Escherichia coli), and in rare cases by a fungal micro-organism (Candida). We report an exceptional case of Candida tropicalis psoas abscess in a 52-year-old man with no history of pathology who had inflammatory lower back pain with fever and general deterioration. The biological assessment showed a renal insufficiency and a biological inflammatory syndrome, a computed tomography made in urgency was in favor of a psoas abscess. The bacteriological study of percutaneous drainage product allowed to isolate Candida tropicalis.

Immune thrombocytopenia associated with malaria: a case report.

The association of immune thrombocytopenic with malaria is a rare event. We describ the case of a young soldier who, after returning from Central Africa, presented a fever associated with petechial purpura and gingivorrhagia, hemogram showed deep thrombocytopenia and macrocytic normochrome anemia, thick peripheral blood smears confirmed the diagnosis of Plasmodium falciparum malaria, the patient was treated with quinine, but deep thrombocytopenia and hemorrhagic manifestations persisted, the patient then underwent corticosteroid therapy, with favorable evolution and progressive normalization of platelets.

Malaria following a blood exposure accident: about a case.

Each year, hundreds of cases of malaria are reported in Morocco and occur after anopheles in patients who have stayed in endemic areas, but transmission following an accident of exposure to blood is rare or exceptional, only about 20 cases are published. We report a case of malaria in a nursing staff following an accidental sting with a catheter needle.

[Primary plasma cell leukemia: about 3 cases]. / Leucémie à plasmocytes primitive: à propos de 03 cas.

Plasma cell leukemia is a rare hematologic malignancy defined by the presence of more than 20% of leukocyte count plasma cells or by a number of circulating plasma cells greater than 2 × 109/L (2G/L). It may be primary in 60% of cases and it manifests itself immediately as a leukemia or as a secondary event, in 40% of cases, complicating a previously diagnosed multiple myeloma. Given the rarity of this condition, only a few cases have been reported in the literature. It is characterized by its aggressiveness and poor prognosis. This study reports 3 cases diagnosed in the hematology laboratory of Mohamed V Military Hospital and aims to describe the clinical, biological and prognostic features of this disease.

[Antibacterial activity of antiseptics used at Military Teaching Hospital Mohamed V of Rabat]. / Activité antibactérienne des antiseptiques utilisés à l'Hôpital militaire d'instruction Mohamed V de Rabat.

Antiseptics have a major role against the infections and their prevention. The good management of antiseptics allows the reduction of antibiotics use and thus the emergence of resistant bacterial strains. The evaluation of the antibacterial activity of three antiseptics (povidone iodine [PVPI], iodized alcohol and alcohol 70 degrees) used at HMIMV and taken from pharmacy was based on AFNOR method NF T 72-150. The analysis of their chemical properties were done by standardized methods (manganimetry, Bunsen's method, test to determine sodium thiosulfate levels [or sodium thiosulfate test] and Guy Lussac alcoholmeter). Our results were compared with those obtained in another two university hospitals of Rabat: Hospital of Speciality and Ibn Sina. The frequencies of resistant bacterial strains were respectively 4.6%, 30.7% and 15.4% to PVPI, alcohol iodized and alcohol 70 degrees . Our results have shown that the PVPI is the best antiseptic in our hospital.