Pulmonary tuberculosis: Diagnostic delay in Tunisia.

OBJECTIVE: Early diagnosis and prompt effective therapy are crucial to fight against tuberculosis (TB), particularly in regions with a high prevalence. We aimed to evaluate TB diagnostic delays and identify the associated risk factors. METHODS: We conducted a survey in various health facilities in Tunisia between March 24th and October 30th, 2014. We included all patients aged ≥ 18 years who presented with pulmonary TB (PTB) and who had been initiated on an anti-TB treatment. We evaluated the time between respiratory symptom onset and treatment initiation. Treatment delays were divided into three categories: delays due to the patient, to the healthcare system, and overall delays. RESULTS: We included 352 patients in the study (242 men and 110 women). The mean age was 42.2 years±17.7. The median time from symptom onset to treatment initiation was 52.56 days. Patient delays were longer for men, for patients presenting with alcohol dependence, and for patients who already knew they were sick. Healthcare system delays were associated with older age, female patients, patients consulting a private physician, and outpatients. CONCLUSION: TB symptoms should be better explained to the population and healthcare professionals should be better trained to both reduce such delays and initiate treatment as early as possible.

[Venous thromboembolism in patients with acute tuberculosis]. / Maladie veineuse thromboembolique au cours de la tuberculose.

BACKGROUND: Studies have demonstrated a link between tuberculosis and hypercoagulable state, with reported rates of 0,6%-10% venous thromboembolism (VTE) in all adults with tuberculosis. The present study aimed to evaluate the current incidence and characteristics of VTE in a large sample of patients with acute tuberculosis. METHODS: We report a retrospective study about 26 patients who have confirmed tuberculosis complicated with VTE disease. RESULTS: Sixteen men and ten women were brought together. The mean age was 42.58 years. The thromboembolic complication revealed tuberculosis among 5 patients, appearing during hospitalization of 21 patients among which 16 of them receiving antituberculosis drug. We have listed 10 cases of immediate pulmonary thromboembolism and 16 cases of deep vein thrombosis complicated with pulmonary embolism in 6 cases. Oral anticoagulation drug were associated with heparin after a mean of 4.57 days. Duration average of achievement of an effective dose was of 21.05 days and we prescribe low molecular weight heparin for 6 months on 2 cases. There was favorable evolution among 14 patients, 4 of them have lost sight and the evolution was fatal by cataclysmic haemoptysis in one case, a patient died hepatocellular insufficiency and 6 died by pulmonary embolism. CONCLUSION: Immunological and hematological abnormalities are incriminated in the genesis of VTE disease during tuberculosis by creating hypercoagulate state. The accumulation of morbidity of these two affections as well as the difficulty of therapeutic care made by medical interaction ifampicin-anticoagulants aggravate the prognostic.

Recurrent iliac hydatidosis: A case report.

INTRODUCTION: Hydatid cysts may occur in any area of the body, but they usually localize to the liver and the lungs. Primary localization in bone is not common. PRESENTATION OF CASE: The authors report the case of multifocal hydatid disease appeared 3 years after the surgical treatment of a cyst of the hip. The patient presented with cough and chest pain of 2 months duration. Only the lung localization was symptomatic. The thoracic echography, the abdominal and chest scan allowed the diagnosis. DISCUSSION: Hydatid recurrence remain frequent, whatever is the nature of the treatment, surgical or chemical. CONCLUSION: The premature detection of recurrence is of great importance.

[Treatment of tuberculosis]. / Traitement de la tuberculose.

The aim of this article is to give practicing physicians a practical approach to the treatment of latent and active tuberculosis. Most patients follow TB standard treatment recommended by WHO that depend on category of patient. It is a combination of four essential tuberculosis drugs of the first group: isoniazid, rifampicin, pyrazinamid and ethambutol; in some cases streptomycin can replace ethambutol. This initial phase of intensive treatment is followed by a consolidation phase. Drugs should be administered in the morning on an empty stomach one hour before meals. Treatment of latent tuberculosis (TB) infection is an important component of TB control programs. Preventive treatment can reduce the risk of developing active TB.

[Bilateral pleural thickening]. / Épaississement pleural bilatéral de la plèvre.

The authors report the case of a 20-year-old man in whom pulmonary and bone tuberculosis presented as bilateral pleural thickening without effusion.

[Symptoms and natural history of hospital chronic obstructive pulmonary disease]. / Symptômes et histoire naturelle de la broncho-pneumopathie chronique obstructive en milieu hospitalier.

BACKGROUND: Since few years, the data describing the chronic obstructive pulmonary disease (COPD) have changed and new concepts have emerged. AIM: To study the clinical characteristics and outcome of patients with COPD in a Tunisian population. METHODS: It is a retrospective study including 150 patients with COPD admitted at the pulmonary department of Charles Nicolle Hospital in Tunis, during a period of ten years. RESULTS: Data from 150 patients hospitalized at the pulmonary department of Charles Nicolle Hospital in Tunis, were analyzed. They were 126 men and 24 women with a mean age of 67 years. Tobacco was the predominant risk factor. Eighty-two (55%) patients were classified GOLD stage IV at diagnosis. The number of exacerbation varied from 1 to 7 with an average higher in patients classified as stage IV (p = 0.007). CONCLUSION: The COPD is pathology of smoking men. Comorbidities and exacerbations prevalence increase according the disease severity. In fact, better knowledge of exacerbations etiologies allows considering better measurement of prevention.

[Treatment of recurrent pulmonary tuberculosis]. / Traitement des récidives de tuberculose pulmonaire.

INTRODUCTION: Tuberculosis (TB) is a greatest public health problem of the world. This work aims to study the antituberculous treatment and the evolution of the patients with recurrent tuberculosis. PATIENTS AND METHOD: The study is a retrospective study on 64 patients with recidivant pulmonary TB: A1 group: at the first TB attack; A2 group: at the time of recidivant TB, and 105 controls patients with confirmed TB without recidive. RESULTS: Multidrug-resistant TB is more frequent with recidivant TB (21.1% vs 3%, P<0.05) and also extensively drug-resistant. Antituberculous treatment duration in group A1, A2 and T was respectively 8.63 months, 9.79 months, and 7.08 months. Antituberculous drug complications were more frequent in group A2 compared to group T (76.1% vs 41.2%; P<0.001). CONCLUSION: All tuberculous patients, specially recidivant TB, should benefit of particular care and drug protocol adaptation.

[Predictive factors for recurrence of pulmonary tuberculosis in Tunisia: a retrospective study]. / Facteurs prédictifs des récidives de tuberculose pulmonaire en Tunisie: une étude rétrospective.

INTRODUCTION: Tuberculosis is still endemic in Tunisia. Even though recurrent TB (RT) is rare, there is an increased risk of resistance. The purpose of this study is to investigate predictors of RT. PATIENTS AND METHODS: This was a case controlled retrospective study, comparing two groups of patients with confirmed pulmonary tuberculosis: a relapse group (GR) of 64 patients with RT and a control group (GT) of 105 patients. RESULTS: Between September 1995 and December 2007, the incidence of RT was 9.48%. All the patients were male. There was no difference in the average age of the two groups. A smoking history of greater than 20 pack-years was more common in the GR (44.89% versus 21.4%, P=0.055). No difference was found regarding the history and clinical signs except that chest pain and dyspnoea were more frequent in the GR. A low haemoglobin was more common in the GR (11.33 ± 1.57g/dL versus 12.41 ± 1.66g/dL, P=0.008). The tuberculin skin test was negative in 73.7% of GR versus 31.1% of GT (P=0.001). Adverse liver reactions are more frequent in the GR (27.3% versus 8.6%, P<0.05). Discontinuation of TB treatment was more common in the GR (36.7% versus 3.8%, P<0.001). The achievement of sputum negativity was delayed in the GR (46.32 ± 54.01 versus 9.35 ± 11.84 days, P<0.001). Despite this, we have noted no significant difference in drug resistance. In multivariate analysis, hepatic cytolysis and a negative tuberculin skin test were independent predictive factors for RT. CONCLUSION: All tuberculous patients should have a carefully adapted treatment regimen, particularly the presence of factors predictive for recurrence.

[Lung mycosis in non neuropenic patients]. / Infections pulmonaires mycosiques chez des patients non neutropéniques.

UNLABELLED: Lung mycosis is rare. Diagnosis and treatment must be done the earliest possible. METHODS: It is about a retrospective study on clinical records including patients hospitalized for lung infection. RESULTS: From 2008 to 2011, 16 patients (13 men and three women, average age 42 years) developed a pulmonary infection. Twelve of our patients had respiratory or extrarespiratory histories. None of our patients had a neutropenia. The diagnoses were lung aspergilloma in four cases, invasive lung aspergillosis in three cases, allergic bronchopulmonary aspergillosis in three cases, mucormycosis in three cases, trichosporonosis in a case, actinomycosis in one case and penicilliosis in one case. An antifungal treatment consisting in amphotericin B or itraconazole was given to four patients and six patients, respectively. Surgery was chosen for six patients. The evolution was good for 12 patients, one presented renal failure, and three patients died.

[Haemoptysis revealing tracheobronchial amyloidosis]. / Hémoptysie révélatrice d'une amylose trachéobronchique.

The authors report the case of a 68-year-old man complaining of haemoptysis and breathlessness. Bronchoscopy revealed a budding formation in tracheal bifurcation. Multiple biopsies were performed and concluded as to AL type amyloidosis. Tracheobronchial amyloidosis is an uncommon localised form of amyloidosis that can simulate lung cancer.

[Invasive inflammatory pseudotumor of the lung]. / Pseudotumeur inflammatoire pulmonaire invasive.

Inflammatory pseudotumor of the lung is an uncommon nonneoplastic tumor of unknown origin. It can mimic lung carcinoma. We report a 65-year-old man who presented with productive cough, weight loss, and a heterogeneous right apical lung condensation. This clinical and radiographic presentation suggested a malignant lung tumor. Surgery was performed and the histological examination of the surgical specimen concluded to an inflammatory pseudotumor. A pneumonectomy was performed because of the tumor extension towards the lower lobe and the mediastinum. No recurrence was observed after a 2-year follow-up. Surgery is essential to confirm the diagnosis of inflammatory pseudotumor. Complete resection is the only guarantee to prevent recurrence.

[Persistent pleuropneumopathy in a young woman]. / Une infection pleuropulmonaire non résolutive chez une femme jeune.

Bronchopulmonary sequestration is a rare malformation characterized by lung tissue fed by one or several aberrant systemic arteries. The authors present the case of a 35-year-old woman in whom extralobar sequestration was fortuitously detected at the time of persistent pleuropneumopathy. Computed tomography was used in the diagnosis of pulmonary sequestration. The most common and recommended treatment is the surgical removal of the pulmonary sequestration.

[Complicated hydatid cysts of the lung]. / Kystes hydatiques compliqués du poumon.

BACKGROUND: Hydatid disease which is caused by the parasite Echinococcus granulosis is one of the most important helminthic diseases. The parasitic infection is endemic in many areas worldwide, including the Mediterranean region. The lung is the second most common involved organ. In the present study, we review cases of complicated pulmonary hydatidosis, discussing pathophysiological mechanisms and the clinical, radiological features, as well as natural history and therapeutic options. METHODS: A retrospective study was conducted in the adult pulmonary department of The Tunis Chest Diseases and Surgery Training Hospital, a tertiary referral hospital for pulmonary diseases in Tunisia. RESULTS: 52 cases (mean age=34.6 years) were evaluated between 1998 and 2008. Rupture of the hydatid cyst occurred into the bronchi in the majority of cases (86.5%) and into the pleura in 9.6%. Extrathoracic involvement was found in 17.3% of the cases. Diagnosis of pulmonary hydatidosis was based on a consistent clinical and radiological presentation. Recourse to CT scan of the chest was helpful for diagnosis in 28% of the patients. Fibre-optic bronchoscopy (performed in 64.5% of cases) confirmed the diagnosis in 4 patients with total endoscopic extraction of hydatid cyst membrane in 2 cases. Surgical treatment was performed in 44 cases; resection of lung parenchyma was necessary in 8 patients (18.2%). Medical treatment was associated in 2 cases. Outcome revealed recurrence of pulmonary hydatidosis in 3 patients, and the death of 1 patient with chronic pulmonary hypertension due to chronic hydatid pulmonary embolism. CONCLUSION: Complicated pulmonary hydatidosis may present some diagnostic difficulties, even in endemic regions. Management may be difficult, costly, and may require pulmonary resections.