A Case of Colonic Tuberculosis Revealed by Polymerase Chain Reaction.

BACKGROUND: The authors report a case of tumor-like colonic tuberculosis revealed by PCR in a 32-year-old patient with a low-level peritoneal effusion on CT scan with negative histological study on colonic biopsy. METHODS: The colonic biopsy received at the laboratory after grinding in a porcelain mortar, was the object of a molecular study by GeneXpert MT/RIF (Cepheid, Sunnyvale, CA, USA) using the automated real-time PCR technique and a conventional study based on Ziehl-Nielsen staining and culture on Lowenstein-Jensen® solid medium (LJ) and Mycobacteria Growth Indicator Tube (MGIT®) liquid medium. RESULTS: The patient was a 32-year-old male without any personal or family history of tuberculosis and without signs of tuberculosis impregnation. He had a story of ingestion of non-pasteurized dairy products including milk and cheese. For 45 days he had constipation with abdominal pain and feeling of heaviness. Physical examination of the patient revealed abdominal tenderness without adenopathy. The laboratory workup showed a normal blood count, CRP, liver and kidney function tests. The HIV test was negative. Medical imaging revealed a low-level peritoneal effusion that could not be punctured. Colonoscopy showed a thickening of the colon. The colonic biopsy, after crushing and sonication, was searched for the Mycobacterium tuberculosis complex by both molecular biology and conventional methods. Molecular research by GeneXpert MTB/RIF (Cepheid, Sunnyvale, CA, USA) using the automated real-time PCR technique, revealed the presence of the Mycobacterium tuberculosis complex without detection of rifampicin resistance. On the other hand, the direct examination after special Ziehl-Nielsen staining was positive (Figure 2) and the cultures on Lowenstein-Jensen® solid medium (LJ) and Mycobacteria Growth Indicator Tube (MGIT®) liquid medium were also positive after two and three weeks, confirming the molecular diagnosis. The histology study showed moderate non-specific chronic colitis with no histological arguments for tuberculosis or malignancy. The patient was placed on curative tuberculosis treatment according to the national protocol, with a favorable clinical-radiological course. CONCLUSIONS: Colonic tuberculosis is a disease that may mimic many other diseases; therefore, a correct approach is necessary for the correct diagnosis and treatment.

Infective endocarditis caused by Escherichia coli of a native mitral valve.

Escherichia coli is a rare cause of infectious endocarditis. We report a clinical case of E. coli endocarditis of a native mitral valve in a young 26-year-old woman with a recurrent urinary tract infection who had a high fever for one week despite probabilistic treatment with amoxcillin-clavulanic acid 3 g per day. The patient was successfully treated with antibiotics and recovered without surgery.

Septic arthritis of the ankle: Do not forget Pasteurella pneumotropica.

Pasteurella pneumotropica is an important bacterial pathogen in both animals and humans. Most reported Pasteurella infections in humans involve skin and soft tissues, often after an animal bite, scratch, or lick to an open wound. We report a case of septic arthritis with Pasteurella pneumotropica in a diabetic and cardiopathic patient who was the victim of a rat bite in the street, with a good evolution after medical and surgical treatment.

The stability and accuracy analysis of automatic steering system with time delay.

The paper presents a systematic method of stability analysis for automatic steering system involving a time delay and some external disturbances. The analysis focuses on the stability of automatic steering system with increase of the time delay from zero to infinity. Firstly, the structure and dynamic model of automatic steering system are briefly introduced, and PD control algorithm is adopted to further analysis the time delay mechanism of control system of automatic steering system. Then the time delay dynamic models of automatic steering system with PD control algorithm are derived, the time delay stability interval and critical time delay of automatic steering system are calculated by using the generalized Sturm criterion method. Finally, the accuracy of critical time delay calculation by proposed method, and the stability and accuracy of automatic steering system with time delay and external disturbance are illustrated by numerical simulations.

[Frequency and antibiotic susceptibility of bacteria identified in urine]. / Fréquence et sensibilité aux antibiotiques des bactéries isolées dans les urines.

OBJECTIVE: The authors had for aim to evaluate the frequency of isolation and the antibiotic susceptibility of bacteria responsible for urinary infections among in and out-patients. METHODS: A retrospective study was carried out at the Microbiology Laboratory of the Mohammed-V Military Instruction Hospital in Rabat, on bacteria isolated from 896 positive cytobacteriologic examinations of urine, from January 1 to December 31, 2005. RESULTS: Among the 7472 urinary samples, 896 answered the criteria of urinary infection (12%). Urinary infections were more frequent in in-patients (57.8%; sex-ratio F/M=1:16). Enterobacteria were the most frequent (85%) and especially Escherichia coli (44.7%). Gram positive bacteria (11.6%) were more frequently Staphylococcus saprophyticus (3.1%). E. coli was highly resistant to amoxicillin, and sulfamethoxazole, whereas quinolones and aminosides maintained a good activity and third generation cephalosporines remain active (97% of susceptibility). Among the enterobacteria present, 3.2% were resistant to third generation cephalosporines with extended spectrum betalactamase.

[Risk of noscomial infection in intertropical Africa--part 1: background]. / Le risque nosocomial en Afrique intertropicale--partie 1: le contexte.

Nosocomial infection is a risk in any health care setting. A review of recent medical literature shows that there is a paucity of information on nosocomial infection in intertropical Africa. Often misunderstood or denied, nosocomial infection is in reality an underestimated public health problem at most medical facilities even university hospital centers. However most hospitals are confronted with the same financial, structural and logistics difficulties, with limited training and awareness about hospital hygiene among caregivers, and with situations bringing together contagious infections with susceptible subjects. Assessment of the risks for patients and caregivers is a necessary prerequisite for implementing measures to control nosocomial infections in intertropical Africa.

[Factitious Cushing syndrome: two case reports]. / Le syndrome de Cushing factice: deux observations.

INTRODUCTION: Search of corticosteroid use is an important precaution before any exploration of hypercorticism. Nevertheless, this use may be factitious leading to serious misdiagnosis and pitfalls. EXEGESIS: We report two cases of 29 and 60 years old male patients, referred for hypercorticism with patent features including metabolic and trophical signs. Laboratories findings revealed unelevated urinary cortisol values (40 and 27 microg/ day) in both cases with normal ACTH and normal plasmatic cortisol response to synacthène (32,5 and 35 microg/dl). Corticosteroid use, initially denied, was finally approved by the patients (hydrocortisone and dexamethasone for the first patient and betametasone for the second). So, they were assigned to psychiatric therapy. CONCLUSION: Our cases emphasize that corticosteroid misuse must be evoked in patients with unexpected hormonal assessment of pituitary adrenal axis despite patent clinical features of hypercorticism. Several specific tests are actually available for detect factitious Cushing syndrome. However, differential diagnostic remains difficult mainly with pseudo Cushing and cyclical Cushing syndromes.

[Incidence of surgical wound infections a prospective study in the Rabat Mohamed-V military hospital, Morocco]. / Incidence des infections du site opératoire étude prospective à l'hôpital militaire d'instruction Mohamed-V de Rabat, Maroc.

OBJECTIVES: The authors had for aim to determine prospectively the incidence of surgical site infections (SSI) in a visceral surgery department, in the Mohamed V military hospital (Rabat), and to identify risk factors. PATIENTS AND METHODS: All patients who had undergone surgery between April 1 and September 30, 2002 and were then admitted in the visceral surgery unit were included in this study. Patients were assessed within the following month. For each patient, data including perioperative factors, type of procedure, and SSI occurrence were collected on a standardized form. RESULTS: During the study, 310 patients were operated. The number of surgical wound infections was 16 (5.2%). This analysis pointed out: 11 superficial wounds, 5 deep wounds, and 1 organ/site wound. Emergency, age, ASA score, Altemeier classification, and procedure duration were found to be risk factors for SSI in visceral surgery. According to the NNIS index, SSI rates increase from 2.7% for patients with a risk index of 0 to 10.2% for patients with a risk index of 3. CONCLUSION: The high incidence of SSI emphasizes the importance of implementing SSI surveillance in surgery to obtain standardized incidence ratios necessary for adapted control measures.

[Rapid immunochromatographic tests for detection of malaria: principles and strategies for use]. / Tests immunochromatographiques rapides de détection du paludisme, principes et stratégies d'utilisation.

Malaria is a parasitological emergency requiring safe quick accurate diagnosis so that appropriate therapy can be implemented. A number of rapid diagnostic tests based on detection of HRP2 Ag, enzymes, LDH or aldolase are now available. However the use of these tests is restricted to trained, experienced staff in special situations. The purpose of this report is to describe the different tests on the market and clarify the limitations for their use.

[Hepatic abscess in diabetics, 2 case reports]. / Abcès hépatique chez le diabétique. 2 observations.

INTRODUCTION: Over the past few years, the hepatic abscess appears as a privileged septic localisation in the case of diabetes mellitus, particularly in the elderly. OBSERVATIONS: Two, 75 year-old and 82 year-old, diabetic patients were hospitalised for non-ketonic decompensation of type 2 diabetes mellitus. Examination revealed a sub-febrile state, the absence of clinical hepatic signs and a biological infectious syndrome The abscesses were discovered during the systematic hepatic sonography. Liver puncture was only possible in one patient and revealed Klebsiella oxytoca. The progression with antibiotics alone in one patient, and associated with surgical draining in the other, was positive. The origin appeared to be bilary in one patient and arterial on the other. COMMENTS: These case reports underline the interest of the systematic evocation of an abscessed hepatic localisation in cases of imbalance in diabetes, particularly when associated with an unexplained infectious syndrome.

[Craniopharyngioma of the adults. Three cases]. / Le craniopharyngiome de l'adulte. A props de trois cas.

Craniopharyngioma, an intra- and suprasellar tumor generally observed in pediatric patients, can also occur in adults. We report three cases of histologically confirmed craniopharyngioma in three men aged 34 to 53 Years. Clinical manifestations were headache with visual and gonadic disorders associating impotence, infertiligy, and gynecomastia. Computed tomographic and magnetic resonance imaging revealed an intra- and suprasellar tumor with solid, hydric, and calcified components. Third ventricle compression was observed in two patients. Hormone test revealed gonadotrope insufficiency in two patients, associated with hyperprolactinemia in one of them, and pituitary insufficiency in the third patient. None of the patients had diabetes insipidus. The frontopterional approach was used for surgery. One patient died and the two others experienced persistent visual impairment with worsening pituitary insufficiency. Our observations suggest that these craniopharyngiomas were probably clinically latent congienital forms since endocrine features were lacking during childhood. Early diagnosis is required to achieve good outcome.

[The effect of seasonal undernutrition on the protein fractions in the blood of Moroccan cattle]. / Einfluss saisonaler Unterernährung auf die Eiweissfraktionen im Blut marokkanischer Rinder.

In a trial including 84 cattle from three farms near Rabat (Morocco) the influence of undernutrition (dry season September to February) on the concentration of total protein and its fractions in the blood of cattle was investigated. The results out of the field were confirmed by comparing these concentrations during an experimental cycle of sufficient--insufficient--sufficient feed. It was obvious that malnutrition decreases the concentration of total protein and some of its fractions (albumins, gamma-globulins) in the blood by about 10%, while alpha- and beta-globulins remained nearly uneffected.

A study on digital diseases of cattle in Morocco.

Digital diseases of cattle, as defined by the "International Council on Digital Diseases of the Ruminants" were studied on 32 farms with various management systems in Morocco. This study involved 953 cattle without lameness for claw examination and 89 lame cattle for detailed clinical examination and semiological trimming of the eight claws. Claw deformities, interdigital dermatitis and ungular erosion, chronic diffuse aseptic pododermatitis, circumscribed pododermatitis and deep digital diseases were described regarding their prevalence and clinical characteristics, including their distribution on fore and hind limbs, and on antero-medial, antero-lateral, postero-medial and postero-lateral claws. Interrelationships between different digital diseases and relationships between some digital diseases and environmental factors were searched by correlation studies. The results are compared with the characteristics of the same digital diseases in other countries.

[Sheehan's syndrome followed by spontaneous pregnancy. Apropos of 2 cases]. / Syndrome de Sheehan suivi d'une grossesse spontanée. A propos de deux observations.

There are few reports of spontaneous pregnancies in patients with Sheehan's syndrome. We describe two cases which exhibited adrenal and thyroid insufficiency but not amenorrhea, return of the menstrual periods being at the expected time after delivery. Endocrinologic studies confirmed thyrotropin and corticotropin insufficiency. Clinical evidence of preserved gonadotropin secretion was supported by the response of LH and FSH to acute administration of synthetic LHRH and by the fact that thyroid and corticoid hormonal replacement resulted in a spontaneous pregnancy with successful outcome.