[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.

[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.

[Virus and Atypical Pathogens Detected in Community-Acquired Lower Respiratory Tract Infection in Infants and Children of Sfax Region, Tunisia]. / Virus et bactéries atypiques détectés dans les infections respiratoires basses communautaires de l'enfant dans la région de Sfax en Tunisie.

Little is known about viral and atypical bacteria pathogen spectra of community-acquired lower respiratory tract infection in children in Tunisia. Thus, a prospective study was carried out between January 2009 and March 2010 in Sfax. Nasopharyngeal aspirates collected from 368 patients (78 with pneumonia and 290 with acute bronchiolitis) were analyzed by indirect immunofluorescence assay and PCR to detect influenza viruses, parainfluenza viruses, respiratory syncytial virus (RSV), human metapneumovirus, human rhinovirus, human enterovirus, adenovirus, coronavirus, Mycoplasma pneumonia (Mpn) and Chlamydia pneumonia (Cpn). One or more etiology was documented in 319 cases (86.7%). The most detected viruses were RSV (42.7%), rhinovirus (32.9%) and adenovirus (28.5%). Co-detection of two or three pathogens was found in 40% of positive samples. This study highlights the importance of respiratory viruses in lower respiratory tract infection in children of Sfax region as well as the high rate of co-detection of multiple viruses, resulting in challenges in clinical interpretation.

Le profil étiologique microbien des infections respiratoires basses (IRB) communautaires de l'enfant a été peu étudié en Tunisie. Une étude prospective a été menée à Sfax entre janvier 2009 et mars 2010 sur 368 enfants hospitalisés pour pneumonie (n = 78) ou bronchiolite aiguë (n = 290). Les aspirations nasopharyngées ont été analysées par immunofluorescence et par PCR à la recherche des virus influenza, virus para-influenza, virus respiratoire syncytial (VRS), métapneumovirus, rhinovirus, entérovirus, adénovirus, coronavirus, Mycoplasma pneumoniae (Mpn) et Chlamydia pneumoniae (Cpn). Une étiologie ou plus a été retrouvée dans 319 cas (86,7 %) : principalement le VRS (42,7 %), des rhinovirus (32,9 %) et des adénovirus (28,5 %). Dans 40 % des prélèvements positifs, deux ou trois agents pathogènes ont été codétectés. Cette étude a permis de montrer la prévalence élevée des virus dans les IRB de l'enfant dans la région de Sfax et leur détection fréquente en co-infection posant la question sur leur rôle pathogène réel.

Comparison of real-time PCR, nested PCR, and galactomannan antigen detection by enzyme-linked immunosorbent assay in sera for diagnosis of invasive aspergillosis.

Conventional methods for diagnosis of invasive aspergillosis (IA) lack sensitivity and specificity. Serological methods still have many cases of cross-reactivity. However, molecular techniques seem to arise as a rapid approach, specific and direct that could be used in the diagnosis of IA. In this study, we analyzed 88 serum samples from patients of having IA using GM-ELISA test, nested PCR with primers for the rRNA 18S of Aspergillus genus and real time PCR specific for A. fumigatus. Among the 88 samples, 64 of them had positive GM titers and 23 had positive nested PCRs; 18 of the 23 PCR-positive samples were also GM-positive. On the other hand, 18 samples were detected positive by reel time PCR; 13 positive samples were also detecting positive by nested PCR. QPCR revealed 26 % of the patients with IA, while nested PCR and galactomannan ELISA revealed respectively 34 % and 94 % of the patients with IA. Probable IA was diagnosed in 18 and possible IA was diagnosed in 6 episodes. Forty-four episodes were defined as not having IA. The positive and negative predictive values were respectively 100 %, and 88 % for QPCR, 100 % and 97 % for nested PCR, and 28 % and 60 % for GM test. These results suggesting that combined use of methods might improve the diagnosis of IA.

Epidemiological and clinical analysis of hepatitis virus A infections during three successive outbreaks in Sfax (Tunisia) between 2007 and 2010.

to describe the epidemiological and clinical characteristics of HAV infection during three successive outbreaks occurring between 2007 and 2010 in the governorate of Sfax. epidemiological and clinical characteristics were retrospectively analyzed from the outbreak investigations. The diagnosis of acute hepatitis A was confirmed by ELISA detection of immunoglobulin M serum antibodies to HAV. 443 patients were identified and 159 of them investigated. Their mean age was 12.2 years and the M/F ratio was 0.9. The most affected age groups were 6-10 years (35%) and 11-15 years (33%). The most likely sources of contamination were drinking water from wells or tanks and direct transmission. The most frequent symptoms included asthenia, digestive disorders, and jaundice. Two cases of fulminant hepatitis were reported, one lethal. our results show that HAV endemicity in the governorate of Sfax has dropped from high to intermediate as demonstrated by the increasing age at primary HAV infection. Strengthening health education and improving access to drinking water would reduce the transmission risk of HAV in our regions.

Activity antifungal of the essential oils; aqueous and ethanol extracts from Citrus aurantium L.

Our study is about the essential oil of Citrus aurantium L. in Tunisia and its plant extract. The yield of this essential oil is 0, 56% but the yield of the extract of plant was 17.1% for the aqueous extract ant 18.3% for the ethanolic extract. The analysis of chemical composition by using GC and GC/MS showed the essential oil of C. aurantium L. species to be rich in monoterpenes such as α-terpineol, lianolyl acetate, linalool and limonene. The antifungal activity of this oil showed us an inhibition of the germination of mushrooms, in the same way we could note that the biologic activities are generally assigned to the chemotypes high content in oxygenated monoterpene.

[Contribution of the chromogenic medium CHROMagar(®)Candida in mycological diagnosis of yeasts]. / Apport du milieu chromogène CHROMagar(®)Candida dans le diagnostic mycologique des levures.

The incidence of invasive candidiasis has increased dramatically over the last decades due to a larger number of patients at risk. The diagnosis remains difficult as the clinical presentation is not specific and the biological diagnosis usually takes several days to become positive. We propose in this work through a prospective study to evaluate the contribution of a chromogenic medium CHROMagar(®) (Becton-Dickinson) in the mycological diagnosis of Candida. We selected 680 samples from patients hospitalized in the intensive care unit for epidemiological surveillance over a period of 11 weeks. We treated samples by culture on Sabouraud and on CHROMagar(®). The species identification was performed by chlamydosporulation test and carbohydrate assimilation tests. We found that the CHROMagar(®)Candida evaluated in our work was a valuable tool in the primary culture in differentiating the most frequently isolated yeast species and in better detection of mixed cultures.

Screening of ΔF508 mutation and IVS8-poly T polymorphism in CFTR gene in Tunisian infertile men without CBAVD.

It is well established that cystic fibrosis transmembrane conductance regulator gene (CFTR) mutations are involved in congenital bilateral absence of the vas deferens (CBAVD), causing obstructive azoospermia and male infertility. Also, several studies reported a relatively high prevalence of CFTR gene mutations in healthy men presenting reduced sperm quality. In this study, we investigate ΔF508 mutation and IVS8-polyT polymorphism in CFTR gene in Tunisian infertile men without CBAVD. Genetic analyses were performed in 148 infertile patients and 126 fertile individuals. The polymorphic IVS8-polyT tract in CFTR gene was analysed in only 129 infertile patients and 54 individuals of control group. As well, we screened for Y chromosome microdeletions in all infertile patients. No ΔF508 mutation was diagnosed either in infertile patients or in control group. 5T allele of IVS8-polyT tract was found in both infertile men (4.26%) and fertile individuals (8.33%). 5T/5T genotype was observed only in two azoospermic patients without Y microdeletions. The most frequent genotype of IVS8-polyT tract in infertile men and controls was 7T/7T (69.75% and 59.25% respectively). There was no association between IVS8-polyT polymorphism and reduced semen quality. Neither ΔF508 mutation nor 5T allele is involved in pathogenesis of male infertility in Tunisian infertile patients without CBAVD.

The CAG repeat polymorphism of mitochondrial polymerase gamma (POLG) is associated with male infertility in Tunisia.

Male fertility largely depends on sperm quality, which may be affected by environmental and genetic factors. Recent data emphasised the implication of the polymorphism of mitochondrial DNA polymerase gamma (POLG) CAG repeats in male infertility. In this report, we explored a possible role of the (POLG) gene polymorphism in male infertility in Tunisian men. The polymorphic CAG repeat in the nuclear POLG gene was studied in 339 male subjects (216 patients with infertility (69 azoospermic, 115 oligoasthenoteratospermic and 32 normospermic) and 123 fertile) after DNA amplification by PCR, followed by genotyping using an automatic sequencer. The heterozygous and the homozygous mutant genotypes (10/ ≠ 10 and ≠ 10/ ≠ 10) were significantly more frequent among infertile patients than among fertile controls (11.2% versus 1.6%, P = 1.3 × 10(-3) and 4.6% versus 0.8%, P = 4.2 × 10(-7) respectively). We also found a significant difference between the frequencies of 10/ ≠ 10 genotype in azoospermic (4.4%) and in oligoasthenoteratospermic (15.6%) infertile patients (P = 2.6 × 10(-2) ). However, the homozygous mutant genotype (≠ 10/ ≠ 10) was seen at similar frequencies in azoospermic, normospermic and oligoasthenospermic men (4.4%, 3.1% and 5.2% respectively). Under our conditions, the findings showed an association between POLG CAG repeat polymorphism and male infertility in Tunisian population.

[Procalcitonin in invasive candidosis]. / Procalcitonine et candidoses invasives en milieu de réanimation.

The use of reliable and specific diagnosis tools in patients of intensive care unit constitutes the best way to follow up these patients and to take charge of severe infections. It is in the context that the measuring of procalcitonin should be considered in order to prove its role in invasive candidosis. This prospective study included 52 patients from an intensive care unit. Blood samples for serum procalcitonin were drawn on days 1, 3, 5. Our results showed that on the one hand, procalcitonin levels have significantly increased in cases of confirmed and probable candidosis. On the other hand, this parameter has a certain prognosis value. In conclusion, an increase in procalcitonin level does not only imply a bacterial infection but it should also evoke a case of invasive candidosis especially in intensive care units.

[Pneumocystis pneumonia in 3 non HIV patients]. / Pneumocystose pulmonaire chez les patients non VIH: à propos de trois cas.

We report 3 cases of pneumocystis pneumonia (PCP) in 2 female and 1 male patients (mean age=50 years) free of human immunodeficiency virus (HIV) infection. One female patient presented with breast neoplasm the other with Wegener's granulomatosis, the male patient with lymphoma. All patients were taking immunosuppressive treatment at the time of infection. Persistent cough, dyspnea, and severe hypoxemia were the most characteristic clinical signs. All patients presented with lymphopenia (average CD4-cell count=275/mm3), two with hypoalbuminemia, and one with renal failure. In all cases, the microscopic analysis of bronchoalveolar lavage was used to establish the diagnosis. All patients were treated with trimethoprim and sulfamethoxazole and a tapering dose of corticosteroids. Outcome was favorable for 1 patient, 1 was transferred to the intensive care unit for acute respiratory failure, and 1 died.