Comorbidities, mortality and survival in patients with pyoderma gangrenosum: a Danish nationwide registry-nested case-control study.

BACKGROUND: Pyoderma gangrenosum (PG) is an ulcerative skin disease associated with comorbidities and increased mortality; however, the literature on this topic is scarce. OBJECTIVES: To investigate the mortality, prevalence and risk of comorbidities in patients with PG. METHODS: This nationwide registry nested case-control study included all inpatients and outpatients diagnosed with PG in tertiary dermatology centres in Denmark between 1 January 1994 and 31 December 2016. Each case was matched on date of birth and sex with 10 unique controls. The Danish National Patient Registry was used to identify all patients and to gather information on comorbidity. Information on age, sex, vital status and emigration was obtained from the Danish Civil Registration System. The outcomes were 19 different comorbidities and all-cause mortality. Prevalence was assessed from odds ratios (ORs) for specific comorbidities at the time of PG diagnosis. The risk of developing specific comorbidities and death was assessed using hazard ratios (HRs) obtained using the Cox proportional-hazards model. RESULTS: A total of 1604 patients with PG were matched with 16 039 controls. Some associations were known, e.g. inflammatory bowel disease [OR 19·15 (15·27-24·02), HR 6·51 (4·24-10·01)], while others have not been described previously, e.g. osteoporosis [OR 1·57 (1·22-2·02), HR 2·59 (2·08-3·22)]. Mortality was significantly increased among patients with PG [HR 2·79 (2·57-3·03)]. CONCLUSIONS: Patients with PG have increased mortality and an increased prevalence and risk of both previously reported and novel comorbidities that may have severe consequences if left undiagnosed. Our findings are mainly related to moderate and severe PG.

Cross-sectional study of cattle lice infestation in the region of Nabeul in north-east Tunisia.

This cross-sectional study is the first to estimate the prevalence of cattle pediculosis in Tunisia. A total of 39 cattle farms in the region of Nabeul in north-east Tunisia were visited and lice were collected by intensively brushing 789 cattle. The prevalence was estimated to be 20.5% on the farms (8/39) and 4.7% in animals (37/789). Collected parasites were examined under a stereomicroscope and three lice species were identified: Bovicola bovis, Linognathus vituli and Haematopinus eurysternus. Thirty-two animals were infested with the chewing lice B. bovis (4%), three with H. eurysternus (0.4%) and two with L. vituli (0.2%). The infestation prevalence was higher in calves under eight months of age (21.6%)than in adults (0.8%). Decision-makers in animal health should consider this parasitic disease in their control and eradication programmes.

An in silico immunological approach for prediction of CD8+ T cell epitopes of Leishmania major proteins in susceptible BALB/c and resistant C57BL/6 murine models of infection.

It is well established that MHC class II restricted-CD4 T cells are dominant during the development of immunity against Leishmania (L) in the C57BL/6-resistant mouse strain. However and in agreement with a number of previous observations indicating that specific CD8 T cells are primed during natural infection or vaccination in humans, a great deal of evidence obtained recently with the susceptible BALB/c murine model of infection by Leishmania major indicates that CD8 T cells participate in both pathogenesis and immunity to cutaneous leishmaniasis. Our goal herein was to identify in silico all parasitic peptides present in the whole L. major predicted proteome, using several public computational systems for the prediction of peptide binding to all MHC (histocompatibility complex-2) molecules in BALB/c and C57BL/6 mice (Syfpeithi, Rankpep, PRED(BALB/c) and Bimas). Peptides that were predicted to bind to different H2 molecules were then analysed for their homology with any of the murine proteins annotated so far, using the BLAST algorithm. Sets of selected peptides for each H2 molecule were defined by different prediction systems and compared to each other. Surprisingly, the results showed that a higher number of L. major peptides were predicted to bind H2 BALB/c molecules and very few or none to bind H2 C57BL/6 molecules. Our finding illustrates how a hybrid immuno-computational approach may be useful for biologists to target an in silico set of selected proteins to define potential candidate antigens for experimental vaccination with greater accuracy as well as a reduced number of T cell antigens.

[Azathioprine for prevention of postoperative recurrence in Crohn's disease]. / L'azathioprine dans la prevention des recidives post operatoires de la maladie de Crohn.

BACKGROUND: Crohn's disease is a chronic inflammatory bowel disease that can involve any portion of the gastrointestinal tract. Up to 74% of patients require surgery. However, although resective surgery improves the clinical situation, relapses is frequent in most cases. THE AIM of this clinical trial was to evaluate the profile of patient who received AZA after surgical treatment in order to prevent postoperative recurrence. METHODS: This was a retrospective study including 17 patients with severe Crohn's disease attending our gastrointestinal unit from September 1998 to June 2004. Patients were eligible if they have severe Crohn's disease, undergoing curative surgical treatment and received azathioprine for the first time after surgery to prevent postoperative recurrence. RESULTS: The study population comprised 17 patients with Crohn's disease (10 men and 7 women; mean age, 27 years). The Crohn's disease was ileo-colic in 10 cases with perineal manifestations for 2 patients and ileal in 7 cases. The indications for surgery were stenosis in 10 cases, fistula in 5 cases, perforation in 1 case and corticosteroid-resistance in 1 case. The median following-up period was 40 months (9-80 months). During this period, only 1 patient reported severe adverse event and discontinued treatment due to acute pancreatitis. 1 patient was lost to follow-up and 3 patients had moderate clinical relapse. Maintained remission was obtained for 12 patients. None of our patients had surgical relapse. CONCLUSION: The result of this study shows the effect of Azathioprine in preventing both clinical and surgical relapses in patients with Crohn's disease who have undergone surgery.

[Antimicrobial susceptibility of Streptococcus agalactiae strains in Monastir]. / Sensibilité aux antibiotiques des souches de Streptococcus agalactiae à Monastir.

OBJECTIVE: The aim of this study was to determine the antimicrobial susceptibility of Streptococcus agalactiae strains in Monastir (Tunisia). METHOD: This retrospective study included 300 strains of S. agalactiae from several pathological samples collected at the Monastir Fattouma Borguiba Hospital. The identification was based on conventional bacteriological features. Serogrouping was performed using agglutination tests. The susceptibility to antibiotics was studied according to the Antibiogram Committee of the French Society of Microbiology recommendations. RESULTS: S. agalactiae was mainly isolated from patients with vaginal infections (31.3%) and urinary tract infections (24.7%). All strains were susceptible to penicillin G. Resistance was mostly observed to erythromycin (38.5%) and lincomycin (36.6%). 6.5% were highly resistant to kanamycin and 0.6% to gentamicin. CONCLUSION: Penicillin remains the most effective antibiotic, but resistance to other antibiotics is emerging. This justifies the routine studying of antimicrobial susceptibility in S. agalactiae stains.

[Vaginal colonization of the Streptococcus agalactiae in pregnant woman in Tunisia: risk factors and susceptibility of isolates to antibiotics]. / Portage vaginal de Streptococcus agalactiae chez la femme enceinte en Tunisie : facteurs de risque et sensibilité aux antibiotiques des isolats.

Streptococcus agalactiae or Group B Streptococcus (GBS) is one of the main bacterial causes of serious infections in newborns. We have evaluated prospectively GBS vaginal colonization in pregnant women and we have tried to determine the risk factors of the colonization by GBS and the particularities of the different isolated strains. We have screened 300 pregnant women with vaginal and anal sample in a same swab. Thirty nine (13%) pregnant women are colonized by SGB, 0% in the first trimester, 10.2% in the second trimester and 17% in the third trimester. Different factors are associated significantly with GBS colonization: past history of infection in newborns, genital infection during pregnancy and parity The highest rates of resistance are found in tetracycline (97.4%), erythromycin (51.3%) and lincomycin (46.2%). All the strains were susceptible to amoxicilin and pristinamycin.

[Multiclonality of methicilin-resistant Staphylococcus aureus in a university hospital]. / Multiclonalité des souches de Staphylococcus aureus résistantes à la méthicilline dans un CHU.

OBJECTIVE: The methicillin resistance of Staphylococcus aureus MRSA is a major problem for human infections. The authors present a genotypic study of these bacteria to understand the spreading of these strains in a university hospital. PATIENTS AND METHODS: We collected 19 strains of MRSA (September 2003-March 2004) for which the presence of gene mecA had been confirmed by PCR. They were then genotyped in pulsed-field Gel electrophoresis (CHEF variety). RESULTS: Resistant strains accounted for 12.9% of all collected S. aureus strains. Most samples came from patients hospitalized or consulting in dermatology. Eleven different antibiotypes and four genotypic profiles were determined: type A (with 8 subtypes), type B (with 2 subtypes), type C, and D. CONCLUSION: MRSA strains have a multiclonal distribution in our hospital with a dominant endemic clone in the dermatological unit. Skin infections are the main hospital source for these strains.

Evaluation of a cefoxitin disk diffusion test for the routine detection of methicillin-resistant Staphylococcus aureus.

Two oxacillin disk methods were compared with a cefoxitin disk diffusion test for detection of methicillin-resistant Staphylococcus aureus (MRSA), with PCR for mecA as the reference method. When tested with 115 MRSA and 350 methicillin-susceptible S. aureus isolates, the cefoxitin disk test (specificity 100%, sensitivity 96.5%) was superior to the oxacillin disk methods (specificity 99.1%, sensitivity 90.4%). Testing with both oxacillin and cefoxitin disks would give better sensitivity (100%) than the cefoxitin test alone, but at the expense of specificity (99.1%). The cefoxitin disk test required no special test conditions and would improve the reliability of routine tests for detection of MRSA.

Evolution of acquired resistance to third-generation cephalosporins in Enterobacteriaceae in a Tunisian hospital 1993-2001.

Between January 1993 and December 2001, the overall frequency of resistance to third-generation cephalosporins in isolates of Enterobacteriaceae from Charles Nicolle Hospital, Tunis, rose from 2.4% to 7.4%. Klebsiella pneumoniae was the most prevalent species (56%), followed by Escherichia coli (15%) and Proteus mirabilis (9%). A rate of 49% was observed among isolates from paediatric patients in 1999, caused mostly by outbreaks in the neonatal intensive care unit of K. pneumoniae and P. mirabilis isolates that produced extended-spectrum beta-lactamases.

[Profile and sensitivity to antibiotics of 115 staphylococcal strains implicated in septicemia in a Tunisian general hospital]. / Profil et sensibilité aux antibiotiques de 115 staphylocoques impliqués dans des septicémies dans un hôpital général tunisien.

Staphylococci remain among the main responsible bacteria for septicemia. The resistance to antibiotics already makes a prognosis difficult. We carried out a study on Staphylococcus isolated from blood culture on 3 years in general hospital in Tunisia. We present the different species and their sensitivity to antibiotics. S. aureus is the predominant isolated species. S. epidermidis is essentially isolated in newborn intensive care unit. The meticillino-resistance concerns 14% of the whole strains and 5.2 of the S. aureus. No resistance is found as regard the vancomycin and the pristinamycin; ofloxacine is inactive on 14.8% of strains and the gentamicine on 11.3%. The resistance of staphylococci of our study is lower than the rates reported in southern Europe and in North America.