[Epidemiology of nosocomial bacterial infection in a neonatal intensive care unit in Morocco]. / Épidémiologie de l'infection nosocomiale bactérienne dans un service de réanimation néonatale marocain.

In neonatal intensive care units, the incidence of nosocomial infection is high. This study aimed to determine the epidemiology of a nosocomial bacterial infection in the neonatal intensive care unit of Mohamed VI university hospital. A total of 702 newborns were included in this study. Of the 702 neonates studied, 91 had developed a nosocomial infection. The incidence rate was 13% and incidence density was 21.2 per 1000 patient-days. The types of infection were: bloodstream infections (89%), pneumonia (6.6%), meningitis (3.3%), and urinary tract infections (1.1%). Nosocomial infection was particularly frequent in cases of low birth weight, prematurity, young age at admission, umbilical venous catheter, and mechanical ventilation. Multiresistant bacteria included enterobacteria producing betalactamase (76.9%), especially enterobacteria that were dominated by Klebsiella pneumoniae (39.7%). The mortality rate was 52.7% in nosocomial infections, 19 (20.87%) of whom had septic shock. The results of this study show that nosocomial infection is an intrahospital health problem that could be remedied by a prevention strategy.

[Bacteriology of community-acquired peritonitis in children treated in the university hospital of Marrakech]. / Profil bactériologique des péritonites communautaires de l'enfant prises en charge au CHU de Marrakech.

INTRODUCTION: The available microbiological data on community-acquired peritonitis in children are inadequate, and antibiotic therapy is not consensual. Our work aims to study the bacteriology of peritonitis in children in our region and discuss the appropriate antibiotherapy. PATIENTS AND METHODS: A descriptive study spread over one year. We collected cases of peritonitis in which a microbiological study of peritoneal fluid was performed. RESULTS: Of 38 cases, the most frequently isolated bacteria is Escherichia coli (E. coli) (50%). Its sensitivity was 64% to amoxicillin-clavulanate, 93.33% to third generation cephalosporins (C3G) and 100% to ertapenem and aminozides. CONCLUSION: We find a high rate of resistance of E. coli to amoxicillin-clavulanic acid. This prompts us to reconsider our therapeutic approach. We believe that the association C3G+aminoglycoside+metronidazole should be used first-line in the pediatric peritonitis in our context.

Atypical celiac disease: from recognizing to managing.

The nonclassic clinical presentation of celiac disease (CD) becomes increasingly common in physician's daily practice, which requires an awareness of its many clinical faces with atypical, silent, and latent forms. Besides the common genetic background (HLA DQ2/DQ8) of the disease, other non-HLA genes are now notably reported with a probable association to atypical forms. The availability of high-sensitive and specific serologic tests such as antitissue transglutuminase, antiendomysium, and more recent antideamidated, gliadin peptide antibodies permits to efficiently uncover a large portion of the submerged CD iceberg, including individuals having conditions associated with a high risk of developing CD (type 1 diabetes, autoimmune diseases, Down syndrome, family history of CD, etc.), biologic abnormalities (iron deficiency anemia, abnormal transaminase levels, etc.), and extraintestinal symptoms (short stature, neuropsychiatric disorders, alopecia, dental enamel hypoplasia, recurrent aphtous stomatitis, etc.). Despite the therapeutic alternatives currently in developing, the strict adherence to a GFD remains the only effective and safe therapy for CD.

[Neonatal infection with Stenotrophomonas maltophilia (2 case studies)]. / L'infection néonatale à Sténotrophomonas maltophilia à propos de 2 cas.

INTRODUCTION: Stenotrophomonas maltophilia (S.M.) is a Gram-negative bacillus, naturally resistant to cephalosporins and carbapenems, which can colonize different sites and may be responsible for serious infections for which treatment is a real challenge. We report 2 cases of nosocomial S.M. infection in 2 hospitalized newborns in the neonatal intensive care unit. CASE 1: A 3-day-old newborn presented with infection beginning in the respiratory system, treated with ciprofloxacin, and complicated by septicemia, resulting in death. CASE 2: An 11-day-old newborn presented with brain S.M. suppuration: empyema and multiple abscesses were treated successfully with the combination of amikacin and chloramphenicol with good progression in the short and medium terms. DISCUSSION: Some epidemiological studies report that S.M. is the second Gram-negative bacillus responsible for nosocomial infection after Klebsiella pneumoniae. While the respiratory location of the bacterium is typical, cerebral parenchyma damage is rare in the newborn. The treatment remains very delicate and difficult because of this bacterium's drug multiresistance. CONCLUSION: These 2 cases of infection caused by S.M. including respiratory tract infection with bacteremia and cerebral suppuration in newborns have broadened the spectrum of diseases caused by this organism and are a reminder of the emergence of this organism and its natural resistance to several antibiotics.

Epidemiologie et profil de sensibilite des isolats d'hemocultures dans un centre hospitalo universitaire marocain

Introduction : L'antibiotherapie des bacteriemies est generalement empirique dans les premieres 48 heures; fondee sur les connaissances epidemiologiques prealables et sur la frequence de sensibilite aux antibiotiques des bacteries en cause. Objectif : L'objectif de cette etude est de determiner le profil epidemiologique et la sensibilite aux antibiotiques des bacteries isolees des hemocultures dans un centre hospitalo-universitaire; afin d'optimiser l'antibiotherapie probabiliste des bacteriemies en milieu hospitalier.Materiels et Methode : Il s'agit d'une etude descriptive realisee sur une periode de 18 mois; allant de janvier 2008 au juin 2009 au niveau du laboratoire de Microbiologie du CHU Mohammed VI de Marrakech. Resultats : Cent quarante six souches bacteriennes non repetitives ont ete colligees; les bacilles a gram negatif ont represente 52;7. Les especes les plus frequemment isolees etaient Staphylococcus aureus (21;3); Enterobacter cloacae (14); Acinetobacter baumannii (12;3) et Pseudomonas aeruginosa (8;9). La resistance a l'oxacilline etait de 48;3pour Staphylococcus aureus. Aucune souche resistante aux glycopeptides n'a ete trouvee chez les souches d'enterocoques et de staphylocoques isolees. Les enterobacteries etaient resistantes aux cephalosporines de troisieme generation dans 64;3des cas avec un phenotype de betalactamase a spectre elargi. La proportion de bacilles a Gram negatif non fermentaires resistants a l'imipeneme etait de 49;9. Conclusion : Une surveillance epidemiologique des bacteriemies en milieu hospitalier est necessaire pour mieux guider l'antibiotherapie probabiliste

Clinical and immunological status of a newly diagnosed HIV positive population, in Marrakech, Morocco.

OBJECTIVE: To evaluate the clinical and the immune status of newly HIV diagnosed patients, in Marrakech city and its neighboring area, in Morocco. METHODS: We performed a retrospective study on 235 patients who have been previously confirmed for HIV infection, and underwent a CD4 T cells using flow cytometry (FacsCount, Becton Dickinson®). RESULTS: The mean age of patients was 34,3 ± 8,4 years (range: 14-55), with a male predominance (sex-ratio M/F=1.4). On basis of clinical data of the patients, 62% (n=146) of them were categorized as "category C", 18.4% (n=43) as "category B", and 19.6% (n=46) as "category A" according to CDC (Center for Disease Control) HIV classification. Among all of them, 60.4% (n=142) had less than 200 CD4T cells, 26% (n=61) had between 200 and 499 CD4T cells, and only 13.6% (n=32) showed a number of CD4T cells less or equal to 500/mm(3). CONCLUSION: The results of this study reflect a significant delay in the diagnosis of HIV infected patients. Therefore, this delay may compromise timely management of HIV infected individuals and enhances propagation of the epidemic in our country. These data confirm the need for intensifying prevention efforts among high-risk population. Moreover, continuing education in HIV/AIDS among healthcare providers should be reinforced.

[Infantile visceral Leishmaniasis: epidemiological, clinical and biological characteristics. About 93 case reports in the children hospital of Rabat]. / Leishmaniose viscérale infantile : profil épidémiologique, clinique et biologique. A propos de 93 cas.

INTRODUCTION: Infantile visceral leishmaniasis (LVI) is a problem of public health in Morocco. This parasitosis rages to the state of endemic and touches the infants. OBJECTIVES: The goal of this survey is to draw up epidemiological, clinical and biologic profile of LVI in children hospitalized in the Children's Hospital of Rabat, and to prove the contribution of serology in diagnosis of this illness. MATERIAL AND METHODS: This retrospective study concerned all LVI cases gathered in the HER during 5 years (from 1997 to 2001). For every patient included in this study, the authors collected geographical origin, age, sex, clinical data (splenomegaly, fever, hepatomegaly, paleness), and biologic data (numeration formulates red chalk, speed of sedimentation, protein in blood and electrophoresis of the proteins). The myelogram results were also exploited as well as results of serology when they were realized. RESULTS: Ninety-three LVI cases were listed with an age average of 3.5+/-3 years, and a sex ratio of 1.82 (p=0.032). Patients coming from farming surroundings or semi-urban were more numerous than those from cities: 85.5% versus 14.5% (p<0.0001). Most of the patients suffered from splenomegaly, fever and paleness; anaemia was almost constant. In case of hyperprotidemy (43.5%; n=27), the albumin-globulin report was always lower than 1.2. Indirect immunofluorescence was practised among 39 patients with a positive response in 84.6% of the cases. Forty patients whose serums were analyzed by indirect hemagglutination (HAI) had all a myelogram revealing the presence of protozoon, but only 57% of them showed a positive reaction in HAI. CONCLUSIONS: These results confirm that the LVI touches children coming from underprivileged surroundings. The triad, splenomegaly, paleness and fever, is a good element of diagnostic orientation, whereas parasite revelation in bone marrow remains the best way to establish the diagnosis of this illness.

[Autoantibodies in systemic sclerosis: clinical interest and diagnosis approach]. / Autoanticorps au cours de la sclérodermie systémique: intérêt clinique et approche diagnostique.

PURPOSE: This review describes different autoantibodies that are associated to systemic sclerosis disease, in presenting their interest for the diagnosis and prognosis, and suggests an immunologic diagnosis approach. The systemic sclerosis (SSc) is characterized by variant specific autoantibodies (autoAbs). More than 90% of SSc cases have antinuclear antibodies (ANA). Anti-centromere and anti-Th/To antibodies are often associated to the limited SSc and to the CREST syndrome. The anti-topo-isomerase I, anti-RNA polymerases and anti-fibrillarin/U3-RNP Abs are diffuse SSc markers with several organ involvements. The anti-PM/Scl and anti-U1-RNP Abs rather mark overlap shapes with polymyositis and systemic lupus erythematous, respectively. The anti-Ku, anti-B23 and anti-NOR90 Abs are a new generation of less frequent autoAbs that show a relationship with specific subsets of SSc. Another heterogeneous group of Abs, topic of research, is described in SSc as well as anti-fibrillin 1, anti-endothelial cells, anti-annexin V and anti-collagen Abs. Despite the diagnosis of scleroderma is mainly clinical, these different autoAbs constitute a diagnosis and prognosis tools by defining immuno-clinical substes of the disease. Identifying those autoAbs requires a diagnostic strategy with two steps: the indirect immunofluorescence remains the better means of ANA tracking, leading thereafter to other identification specific methods, such immunoprecipitation, ELISA or immunoblotting.

[Oculo-cerebro-renal Lowe syndrome: clinical, biochemical and molecular studies in a Moroccan patient]. / Syndrome oculo-cérébro-rénal de Lowe: étude clinique, biochimique et moléculaire chez un patient marocain.

The oculo-cerebro-renal syndrome of Lowe is a rare X-linked disorder, caused by the inositol biphosphate 5-phosphatase deficiency, localized to the Golgi complex. Several mutations were reported in patient's OCRL gene leading to enzyme deficiency. We report a Moroccan case of OCRL syndrome of Lowe with a neo mutation in exon 10. The patient aged of 19 months was referred to our medical centre because of a psychomotor retardation. He had a medical history of eye abnormalities including cataract and bilateral glaucoma, diagnosed when he was 5 weeks old. Cataract has been treated after chirurgical therapy but ocular hypertonia persisted. Physical examination revealed an axial hypotonia and walking difficulties. Laboratory tests revealed a moderate acidosis (20 mmol/L), a slight decrease of serum phosphate level (24 mg/L) and an increased serum phosphatase activity. Further studies showed mild proteinuria, urinary bicarbonates loosing and generalised hyperaminoaciduria. Based on both clinical and biological data, Lowe syndrome has been suggested. In this context, molecular investigation has been performed using dHPLC/sequencing techniques which allow identifying an original mutation c.776T>C (p.Phe259Ser), localized on the exon 10 of the OCRL gene. The mutation was not found in the probant's mother suggesting a neo mutation. Lowe syndrome is a rare hereditary X-linked disorder resulting from a variety of heterogeneous mutations of OCRL gene. Indeed, numerous mutations have been reported, variations were noted concerning their localization as well as their type. To our knowledge, this is the first report of the neo mutation c.776T>C of OCRL gene and the first published case report of the Lowe syndrome in a Moroccan patient.