RÉSUMÉ
This report describes three cases of tumour-like pulmonary tuberculosis: two patients had stage C3 human immunodeficiency virus (HIV) infection (with uncontrolled HIV-1 in one case) and one patient was immunocompetent. All patients initially presented with general and respiratory symptoms, with radiological findings simulating lung carcinoma. Tuberculosis was diagnosed from microbiological testing and/or histological examination results. A disseminated form was described in one case. All patients were treated successfully with antimycobacterial therapy, with control of HIV infection in both cases.
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Clinical descriptions about influenza-like illness in children seem non-specific during the co-circulation of SARS-CoV-2 and influenza. This paper aimed to summarize recent studies comparing clinical features and outcome, laboratory and radiological findings of COVID-19 patients with influenza patients in the paediatric population.
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Intrathecal baclofen therapy is commonly used for neurologically spastic patients. One of the major complications is hardware infection, which generally requires urgent removal of the pump and the intrathecal catheter, with the risk of severe baclofen withdrawal. We have recently been facing this situation and propose another solution with adapted antibiotic therapy, removal with immediate replacement of the intrathecal catheter, initially connected to an implanted port to continue baclofen administration. A new pump was secondarily implanted, after successful treatment of acute bacterial meningitis due to Streptococcus dysgalactiae.
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Devic's Optic neuromyelitis (OND) is a very rare disease defined as a central nervous system (CNS) inflammation resulting in optic neuritis and/or myelitis. The discovery of a highly specific serum autoantibody biomarker for the diagnosis has triggered a great interest in conducting further research into this disease. The association of OND with Tuberculosis (TB) is even rarer and could be an entirely random conjunction. To our knowledge, we reported the first case of Neuromyelitis Optica associated with pulmonary TB in Tunisia.
Sujet(s)
Bactériémie/microbiologie , Infections sur cathéters/microbiologie , Endocardite/microbiologie , Micrococcaceae/isolement et purification , Sujet âgé de 80 ans ou plus , Antibactériens/usage thérapeutique , Bactériémie/traitement médicamenteux , Infections sur cathéters/traitement médicamenteux , Cathéters/effets indésirables , Ceftriaxone/usage thérapeutique , Échocardiographie/méthodes , Endocardite/traitement médicamenteux , Humains , Mâle , Tests de sensibilité microbienne/méthodes , Micrococcaceae/pathogénicité , Résultat thérapeutiqueRÉSUMÉ
We report the case of a 68-year-old man with long-term receipt of steroid therapy who was diagnosed with cerebral abscesses and pulmonary nocardiosis. This patient displayed only respiratory symptoms. Confirmation of Nocardia farcinica species was achieved by specific PCR sequencing of the 16S ribosome RNA in bronchoalveolar lavage cultures. Cerebral magnetic resonance imaging revealed abscesses. Antibiotic therapy with trimethoprim/sulfamethoxazole was prescribed given the results of susceptibility tests and was maintained for 12 months, with no evidence of relapse afterwards.
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We retrospectively reconstituted the history of evolution and onset of the main symptoms of COVID-19 in 70 patients ([29 males, 41%] with a mean age of 56.7 ± 19.3 [19-96] years). Firstly, pain syndrome defined by headache and/or myalgia and/or arthralgia (87%, n = 61) appeared as the first manifestation 1.6 day after the onset of the illness. Secondly, fever (76%, n = 53), followed by cough (80%, n = 56) and diarrhea (40%, n = 28). Thirty three patients (47.1%) were hospitalized on day 7 (±3) with a mean duration of hospitalization of 6.9 (±5.8 [1-21]) days. Twenty-three patients (32.9%) required oxygen therapy 6.7 (±4.1 [1-13]) days from illness onset. Fifteen patients had a respiratory rate ≥22/min on day 9 (±0.8) and only 8 patients (15%) were admitted or transferred in an ICU on day 10 (±2.7) with a mean duration of hospitalization in ICU of 7.9 (±6.6 [2-21]) days.
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To our knowledge, Complications such as pneumomediastinum and/or pneumothorax during the course of COVID-19 remain rare and their mechanism is poorly described. We present a case of COVID-19 pneumonia associated with spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema in an immunocompetent patient with no past history of smoking or chronic obstructive pulmonary disease (COPD). The only risk factor of this patient was prolonged cough. We hypothesize the mechanism underlying the pneumomediastinum is the aggressive disease pathophysiology in COVID-19 with an incresead risk of alveolar damage.
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INTRODUCTION: No therapy has yet proven effective in COVID-19. Tocilizumab (TCZ) in patients with severe COVID-19 could be an effective treatment. METHOD: We conducted a retrospective case-control study in the Nord Franche-Comté Hospital, France. We compared the outcome of patients treated with TCZ and patients without TCZ considering a combined primary endpoint: death and/or ICU admissions. RESULTS: Patients with TCZ (n=20) had a higher Charlson comorbidity index (5.3 [±2.4] vs 3.4 [±2.6], P=0.014), presented with more severe forms (higher level of oxygen therapy at 13L/min vs 6L/min, P<0.001), and had poorer biological findings (severe lymphopenia: 676/mm3 vs 914/mm3, P=0.037 and higher CRP level: 158mg/L vs 105mg/L, P=0.017) than patients without TCZ (n=25). However, death and/or ICU admissions were higher in patients without TCZ than in the TCZ group (72% vs 25%, P=0.002). CONCLUSION: Despite the small sample size and retrospective nature of the work, this result strongly suggests that TCZ may reduce the number of ICU admissions and/or mortality in patients with severe SARS-CoV-2 pneumonia.
Sujet(s)
Anticorps monoclonaux humanisés/usage thérapeutique , Infections à coronavirus/traitement médicamenteux , Infections à coronavirus/épidémiologie , Infections à coronavirus/mortalité , Unités de soins intensifs/statistiques et données numériques , Admission du patient/statistiques et données numériques , Pneumopathie virale/traitement médicamenteux , Pneumopathie virale/épidémiologie , Pneumopathie virale/mortalité , Adolescent , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Betacoronavirus/effets des médicaments et des substances chimiques , Betacoronavirus/immunologie , COVID-19 , Études cas-témoins , Comorbidité , Infections à coronavirus/anatomopathologie , Maladie grave/épidémiologie , Maladie grave/mortalité , Femelle , France/épidémiologie , Humains , Mâle , Adulte d'âge moyen , Mortalité , Pandémies , Pneumopathie virale/anatomopathologie , Études rétrospectives , SARS-CoV-2 , Indice de gravité de la maladie , Résultat thérapeutique , Jeune adulteRÉSUMÉ
BACKGROUND: Medical publications about anosmia with COVID-19 are scarce. We aimed to describe the prevalence and features of anosmia in COVID-19 patients. METHODS: We retrospectively included COVID-19 patients with anosmia between March 1st and March 17th, 2020. We used SARS-CoV-2 real time PCR in respiratory samples to confirm the cases. RESULTS: Fifty-four of 114 patients (47%) with confirmed COVID-19 reported anosmia. Mean age of the 54 patients was 47 (±16) years; 67% were females and 37% were hospitalised. The median Charlson comorbidity index was 0.70 (±1.6 [0-7]). Forty-six patients (85%) had dysgeusia and 28% presented with pneumonia. Anosmia began 4.4 (±1.9 [1-8]) days after infection onset. The mean duration of anosmia was 8.9 (±6.3 [1-21]) days and 98% of patients recovered within 28 days. CONCLUSIONS: Anosmia was present in half of our European COVID-19 patients and was often associated with dysgeusia.
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Infections à coronavirus/complications , Infections à coronavirus/épidémiologie , Troubles de l'olfaction/épidémiologie , Troubles de l'olfaction/virologie , Pneumopathie virale/complications , Pneumopathie virale/épidémiologie , Adulte , Sujet âgé , Betacoronavirus/physiologie , COVID-19 , Études de cohortes , Comorbidité , Infections à coronavirus/anatomopathologie , Infections à coronavirus/thérapie , Femelle , France/épidémiologie , Humains , Mâle , Adulte d'âge moyen , Troubles de l'olfaction/thérapie , Oxygénothérapie , Pandémies , Pneumopathie infectieuse/épidémiologie , Pneumopathie infectieuse/physiopathologie , Pneumopathie infectieuse/thérapie , Pneumopathie infectieuse/virologie , Pneumopathie virale/anatomopathologie , Pneumopathie virale/thérapie , Prévalence , Tests de la fonction respiratoire , Études rétrospectives , SARS-CoV-2 , Indice de gravité de la maladie , Facteurs tempsSujet(s)
Adalimumab/effets indésirables , Antirhumatismaux/effets indésirables , Syndrome inflammatoire de restauration immunitaire/induit chimiquement , Abcès du foie/étiologie , Tuberculose hépatique/étiologie , Tuberculose miliaire/étiologie , Facteur de nécrose tumorale alpha/antagonistes et inhibiteurs , Adalimumab/usage thérapeutique , Adulte , Antirhumatismaux/usage thérapeutique , Antituberculeux/usage thérapeutique , Substitution de médicament , Association de médicaments , Femelle , Humains , Syndrome inflammatoire de restauration immunitaire/complications , Sujet immunodéprimé , Tuberculose latente/complications , Abcès du foie/imagerie diagnostique , Abcès du foie/traitement médicamenteux , Mésalazine/usage thérapeutique , Rectocolite/complications , Rectocolite/traitement médicamenteux , Tuberculose hépatique/traitement médicamenteux , Tuberculose ganglionnaire/complications , Tuberculose ganglionnaire/traitement médicamenteux , Tuberculose miliaire/diagnostic , Tuberculose miliaire/traitement médicamenteux , Tuberculose splénique/imagerie diagnostique , Tuberculose splénique/traitement médicamenteux , Tuberculose splénique/étiologieRÉSUMÉ
BACKGROUND: Hepatitis B is the main cause of liver disease in the world. Chronic hepatitis B may lead to cirrhosis, liver insufficiency or liver cancer. Tunisia is considered as a country with intermediate endemicity, where hepatitis B presents a real public health problem. The aims of this study were to evaluate the prevalence of viral biomarkers of hepatitis B in healthcare personnel; to look for potential risk factors associated with HbS antigen carriage and to evaluate the prevalence of vaccination in this particular population. METHODS: Sero-epidemiological, prospective and descriptive study, among 2411 healthcare personnel in the Military Hospital of Tunis, during a 5-month period from September 2013 to January 2014. RESULTS: Blood samples were collected from 1497 volunteers among the hospital staff. Two hundred and seventy-one individuals had a positive HbC antibody titer (prevalence 18.1%), including 229 who were positive for HbC and HbS antibodies (prevalence 15.3%), 12 positive for only HbC antibody (prevalence 0.8%), and 30 positive for HBsAg (prevalence 2%). Among HbS Ag carriers, 56.6% reported needle stick and sharp object injuries during their professional careers. Among HbS Ag carriers, there were three patients with a history of acute viral hepatitis with jaundice, and 27 patients (90%) who were asymptomatic and were diagnosed during our study. Among healthcare workers in the hospital, 56.1% were immunized through vaccination (positive HbS antibodies without HbC antibodies), of whom 66% had durable protective immunity (HbS antibodies>100mU/mL). Lastly, 25.8% of the hospital workers remained without any protection against hepatitis B (serology entirely negative) and were then offered a complete vaccination. CONCLUSION: Hepatitis B vaccine is the mainstay of hepatitis B prevention. Safe injection practices, blood safety and promoting wider access to monitoring and screening, care and treatment services for hepatitis B are the best guarantees to prevent and control this disease.
Sujet(s)
Marqueurs biologiques/sang , Personnel de santé/statistiques et données numériques , Vaccins anti-hépatite B/usage thérapeutique , Hépatite B/sang , Hépatite B/épidémiologie , Hépatite B/prévention et contrôle , Vaccination/statistiques et données numériques , Adulte , Anticorps antiviraux/sang , Femelle , Hépatite B/immunologie , Antigènes de surface du virus de l'hépatite B/sang , Hôpitaux militaires/statistiques et données numériques , Humains , Mâle , Adulte d'âge moyen , Études séroépidémiologiques , Tunisie/épidémiologie , Jeune adulteRÉSUMÉ
Candida spp. vertebral osteomyelitis is rare. Clinical presentation is unspecific. Diagnosis requires mycological culture of a biopsy specimen. Therapeutic management is based on prolonged course of azole or liposomal amphotericin B. We report the case of Candida tropicalis vertebral osteomyelitis with epidural involvement in a 27 years-old male patient, followed for S-ß-thalassemia and with a history of candidemia. The fungus was isolated from a needle biopsy of the vertebral disk. The outcome was favorable under antifungal treatment by amphotericin B and voriconazole.
Sujet(s)
Candida tropicalis/isolement et purification , Candidémie/complications , Ostéomyélite/étiologie , Adulte , Amphotéricine B/usage thérapeutique , Antifongiques/usage thérapeutique , Humains , Mâle , Voriconazole/usage thérapeutiqueRÉSUMÉ
The lupus anticoagulant-hypoprothrombinemia syndrome (LA-HPS) - the association of acquired factor II deficiency and lupus anticoagulant - is a rare disease that may cause a predisposition not only to thrombosis but also to severe bleeding. We are reporting on a 36-year-old female patient presenting with co-existing cerebral venous thrombosis and subdural hemorrhage. The coagulation screening showed a prolonged prothrombin time (PT), activated partial thromboplastin time (aPTT), and a normal fibrinogen level and platelet count. Evaluation of the clotting factors revealed decreased levels of factors II (37%). Factors V, VIII, IX and XI were normal. Lupus anticoagulant (LA) was demonstrated by the Dilute Russell's Viper Venom Test (DRVVT). Immunological work-up was positive for IgG type anticardiolipines antibodies (aCL). Successful management consisted first of oral prednisone (60mg/d). Thus, anticoagulation was introduced once factor II had stabilized.