Relapsing fever in a Moroccan man.

Tick-borne relapsing fever is a zoonosis caused by spirochetes of the genus Borrelia, transmitted by hematophagous ticks. This life-threatening condition is still misdiagnosed. We report a case of tick-borne relapsing fever in a 54 year-old man in Morocco with a history of hiking, who was hospitalized for an isolated fever. On admission, the clinical examination showed no specific signs. The laboratory assessment showed inflammatory syndrome with disturbance of the liver function. The blood culture was sterile. Serology was negative for HIV and Lyme disease, as were all the rest of the paraclinical tests. The patient's course was marked by spontaneous resolution of the fever and then, seven days later, the onset of a new episode of fever. Malaria was suspected and a blood sample was sent to the parasitology department. The thick smear and blood smear stained with May-Grünwald Giemsa showed the presence of spirochetes. Tick-borne relapsing fever was diagnosed and the patient responded favorably to treatment by cycline drugs. This disease is poorly known and should be considered in cases of presence of intermittent fever without a specific clinical-laboratory picture, according to epidemiological context. The diagnosis is confirmed by the presence of spirochetes on thick smear and blood or cerebrospinal fluid smear stained with MGG.

[Fusarioses to Fusarium solani in an immunocompetent and immunocompromised diagnosed in military hospital of Rabat]. / Fusarioses superficielles à Fusarium solani chez un immunocompétent et un immunodéprimé diagnostiquées à l'Hôpital militaire de Rabat.

Fusarium are ubiquitous hyalohyphomycoses, usually encountered in the soil. They are the second unusual fungal pathogens after the Trichosporon. Intertrigo Fusarium sp. is a rare achievement. We report a case of intertrigos interorteils in an immunocompetent 45years old and a same case associated with a total onychodystrophy in an immunocompromised 75year-old. Laboratory diagnosis has found Fusarium solani confirmed with the positivity of a pure culture twice. Good progress was noted with terbinafine treatment. One or more aggravating factors must always be sought. These cases are in addition to cases increasingly frequent intertrigo due to Fusarium sp.

Comparison of two antifungal susceptibility testing of Candida sp. isolates using agar diffusion method: Neo-sensitabs® tablets and Bio-rad® disks.

INTRODUCTION: The aim of our study was to evaluate the concordance between the two antifungal susceptibility testing of Candida sp. isolates using agar diffusion method: Neo-Sensitabs(®) tablets and Bio-Rad(®) disks. MATERIALS AND METHODS: This is a prospective study conducted in the Laboratory of Parasitology and Mycology of the Mohammed V military teaching hospital from February to August 2012. Upon receiving blood cultures and peripheral sites samples, the identification of Candida isolates performed using routine phenotypic standard tests and the realization of the antifungal susceptibility was carried out on Neo-sensitabs(®) tablets and Bio-Rad(®) disks. RESULTS: A total of 38 Candida strains were isolated: 15 C. albicans (39%), 13 C. glabrata (34%), 5 C. tropicalis (13%), 4 C. krusei (11%) and 1 C. dubliniensis (3%). There were no significant difference (P>0.05) in susceptibility rate between both methods for all antifungal agents tested except for 5-fluorocytosine. The concordance percentage between two methods was 100% for amphotericin B, 97.4% for fluconazole, 94.7% for voriconazole and 73% for 5-fluorocytosine. CONCLUSION: Both methods are easy to perform, rapid and cost effective. Our results showed the best agreement between the two methods for testing the susceptibility of Candida isolates to amphotericin B, fluconazole and voriconazole while for the 5-fluorocytosine, the concordance rate was low.

[Allergic fungal rhinosinusitis]. / Rhinosinusite fongique allergique (RSF).

INTRODUCTION: Definition, diagnosis and treatment of allergic fungal sinusitis remain difficult and controversial despite the increasing number of publications. We report a case of an allergic fungal sinusitis with a review of the literature. CLINICAL CASE: A 45-year-old man consulted for sinusal polyposis resistant to steroid therapy, clinical examination objectified bilateral nasal polyps and covered with scabs. CT scan of the sinuses disclosed a sinuse filled with a tissue density material containing air with lysis of the left maxillary sinus, hypereosinophilia, the IgE levels were high. Finally, mycological investigation allowed the identification of Aspergillus fumigatus. The patient underwent total ethmoidectomy, histological study found an allergic mucin and inflammatory mucosa with numerous eosinophils. The postoperative course was good and the patient was given oral steroids. The clinical and radiological evolution was favorable without recurrence with a follow-up of three years. DISCUSSION: A set of clinical, radiological, histopathological, immunoallergological and mycological criteria is necessary for precise diagnosis and to avoid fungal drift. The treatment is based on endoscopic surgery associated with corticosteroid.

[Pseudo-tumoral Aspergillus rhinosinusitis of dental origin]. / Sinusite aspergillaire d'origine dentaire dans sa forme pseudo-tumorale.

INTRODUCTION: Sinonasal aspergillosis is caused by the interaction between the sinonasal mucosa with a cosmopolite fungus (Aspergillus), it is on the increase, this is an infection whose evolution is unpredictable requiring early diagnosis and appropriate support. We report a case of Aspergillus rhinosinusitis of dental origin in pseudo-tumoral form with a review of the literature. CLINICAL CASE: A 31 years-old, women, consulted for a right nasal obstruction with purulent rhinorrhea after dental treatment. On examination, there was a bulge of the inner canthus of the right eye and a mass in the right nasal cavity. The CT scanner showed a process of the left naso-sinus cavity centered by calcic image density. The patient underwent a total excision of the mass endoscopically. Mycological and pathological examination concluded that the etiology was Aspergillus fumigatus. The patient had not received any antifungal treatment. The postoperative course was uneventful. The evolution was favourable with no recurrence after 9 months. DISCUSSION: Aspergillus rhinosinusitis of dental origin is usually due to the emergence of canalicular filling paste into the maxillary sinus through and oral cavity and sinus fistula, neglected it can progress to invasive pseudo-tumoral form. The clinical presentation is nonspecific and the diagnosis often involves imaging (scanner). Mycological and histological examinations are essential for diagnosis. The treatment is based on surgery sometimes associated with antifungal treatment.

[Candida albicans endocarditis after treatment of complete atrioventricular canal]. / Endocardite à Candida albicans après cure de canal atrioventriculaire complet.

Infective endocarditis is rare in children, it is rarer after a surgical treatment of atrioventricular canal, and it is exceptional that Candida albicans is the etiologic agent. This is a serious infection found in congenital heart disease with or without surgery. It is potentially lethal, despite diagnostic and therapeutic advances. We report a case of infective endocarditis due to C. albicans after the treatment of a congenital systemic atrioventricular canal in a child with trisomy 21. The diagnosis was suspected on clinical manifestations and cardiac auscultation. Confirmation was provided by positive blood cultures and echocardiography. The large size of the vegetation in the patient was in favor of a fungal etiology, blood cultures allowed to identify the fungus. This observation illustrates a poorly understood disease, with very poor prognosis and which is a potential complication of heart surgery. The improved prognosis should be achieved by shortening the time to diagnosis and optimizing the therapeutic support.

[Aspergillus ethmoiditis associated with orbital abscess]. / Ethmoïdite aspergillaire compliquée d'un abcès orbitaire.

The authors report a case of Aspergillus ethmoiditis associated with an orbital abscess, diagnosed in an immunocompetent 6-year-old child, this is a rare infection and diagnosis is difficult, cause of a delayed treatment and frightening prognosis. Mycoses have emerged as important infections in clinical practice; this phenomenon is explained by the ever-growing number of immunocompromised patients and the increasing number of people traveling in areas where fungal diseases are endemic. Surgery with mycological and anatomopathologic examination can suggest a fungal infection confirmed by culture and contribute to institute adequate treatment.

[Systemic candidiasis in medical intensive care unit: analysis of risk factors and the contribution of colonization index]. / Les candidoses systémiques en réanimation médicale : analyse des facteurs de risque et intérêt de l'index de colonisation.

OBJECTIVES: Description of the epidemiological and clinical characteristics of the patients introducing risk factors of invasive candidiasis. Analysis of risk factors for candidiasis invasive and evaluation of the contribution of colonization index (CI) in the diagnosis of the systematic candidiasis in medical intensive care. PATIENTS AND METHODS: Prospective observational study (October 2007 to October 2009). The selected patients present risk factors of system IC candidiasis with an infectious syndrome or clinical signs suggestive of Candida infection and hospitalized more than 48 hours in medical intensive care unit. Pittet's colonization index was calculated at admission and then once a week added to a blood culture. Patients were classified according to level of evidence of Candida infection and the degree of colonization (CI<0.5, CI ≥ 0.5). RESULTS: The study included 100 patients. Mean age of our patients was 55.8 ± 18.2 years with male prevalence. Neurological disease was the most frequent pathology in admission (48%). The most common risk factors were broad-spectrum antibiotics and foreign material. In the various mycology IC specimens, Candida albicans was the most frequent, followed by C. tropicalis, then C. glabrata. The CI was greater than or equal to 0.5 at 53% of the patients, and less than 0.5 in 47% of the cases. Among the patients, 15% developed an invasive candidiasis. In multivariate analysis, the corticosteroid therapy was associated with a high colonisation (IC ≥ 0.5) and neutropenia with a high risk of systemic candidiasis. The positive predictive value of CI was 26%. The negative predictive value was 98%, the sensitivity and specificity was 93% and 48% respectively. CONCLUSION: CI has the advantage to provide a quantified data of the patient's situation in relation to the colonization. But, it isn't helpful with patients having an invasive candidiasis in medical intensive care unit.

Role of Eosinophilsin parasitic Infections

Eosinophilia; a pronounced increase of eosinophils in the blood or tissues; occurs in numerous important circumstances; like allergic diseases; parasitic infections; and cancer. Helminthic parasites are usually the common parasitic infections witch cause eosinophilia apart from two enteric protozoans; Isospora belli and Dientamoeba fragilis. Infection with helminthes parasites produces immune effector responses and in a reaction to various stimuli; eosinophils are recruited from the circulation into inflammatory foci; where they modulate immune responses via sequences of mechanisms. The defence against organisms that are too large to be phagocytosed; particularly parasitic helminthes seems to be the primary role of eosinophils. In this article; we will discuss some of the biological features of eosinophils and their role in parasitic infections

[Prevalence of intestinal parasitic infections in Moroccan urban primary school students]. / Portage parasitaire intestinal chez l'enfant scolarisé à Salé, Maroc.

Intestinal parasitic infections are among the most widespread of human infections in developing countries, and children are the most vulnerable. The aim of this study was to determine the prevalence of protozoa and intestinal helminthes, as well as the risk factors of intestinal parasites in schoolchildren in Salé city, Morocco. This is a study of incidence and prevalence conducted prospectively over a period of five months in schoolchildren in Salé city. The collection of stool was performed over three days (j1, j3, j5). In addition, adhesive cellophane tape slide evaluation was performed on day 7 for all students included in this work. During the study period, we included 123 students. Seventy-six children (61.7%) were infected by intestinal parasites. The age group 12-14 years is by far the most affected. Protozoa were found in 57.7% (N = 71) of children examined. Amoebae family parasites were predominant. Helminths were present in 26% (N = 32) of the schoolchildren. Forty-five (36.6%) children were poly-parasitized. This work shows that the prevalence of intestinal parasitism is quite high among primary schoolchildren in Salé city. Several parasite species are found. This finding is explained by unhealthy living conditions and poor hygiene, predisposing to endemicity and perpetuation of the transmission. The impact on health is not negligible especially when compounded by malnutrition. The best way to fight this scourge is prevention and awareness.

[Rhinofacial mucormycosis: A case report]. / Mucormycose rhinofaciale : à propos d'un cas.

INTRODUCTION: Mucormycosis is the third among deep fungal opportunistic infections after candidiasis and aspergillosis. It is a rare fungal infection in children, but often fatal, which occurs in immunocompromised patients. It is caused by fungi belonging to the order of mucorales. It causes extensive damage and decaying soft parts. The authors report the case of a sinonasal mucormycosis with fatal outcome in a child suffering from hemophagocytic syndrome. REPORT: PL, aged 23 months, resulting from non-consanguineous parents, hospitalized for management of hemophagocytic syndrome lasting for 2 months suspected on clinical and biological data. This diagnosis was confirmed on histology. The etiological diagnosis was negative. A broad-spectrum antibiotics and corticosteroids was introduced. A month later, the patient developed necrotic lesions in the nose and facing the right maxillary sinus. CT scan of facial mass objectived ethmoïdomaxillary bilateral sinusitis. The mycological examination of a nasal swab showed the presence of non-compartmentalized hyphae, culture on Sabouraud chloramphenicol medium without actidione at 37°C isolated Absidia corymbifera. Treatment with amphotericin B was initiated but not tolerated. The negative trend was rapidly leading to death. CONCLUSION: Rhinocerebral mucormycosis is a rare fungal infection in children, we must know how to keep it in mind. The mycological examination and/or histology of a local levy allows rapid diagnosis. Treatment should be initiated urgently to improve the prognosis.

[Severe keratomycosis due to Fusarium solani induced by a telluric foreign body: About a case in moroccan Sahara]. / Kératomycose grave àFusarium solani induite par un corps étranger tellurique : à propos d'un cas au Sahara marocain.

We report a case of severe keratitis due to Fusarium solani in a young man in the Sahara in Morocco where the climate is arid. This patient reported had a grain of sand in his right eye for a week after a sandstorm. On admission he had a corneal abscess. Despite rapid diagnosis and initiation of treatment with available antifungal drugs: amphotericin B and natamycin eye drops, the prognosis worsened and led to the enucleation of the right eye. Faced with a suspected eye infection after a microtrauma caused by grains of sand carried by a sandstorm, it is important to take biological samples to search for fungal infections among other. It is also important to have new triazole antifungal drugs available to treat ocular mycosis rapidly and effectively.

[Invasive aspergillosis of the cavum associated with candidal meningitis]. / Aspergillose invasive du cavum associée à une méningite à Candida albicans.

Aspergillus fumigatus is a resistant filamentous fungus, common in the environment and pathogenic for human. The most common sites of primary aspergillosis are the maxillary sinus and lungs. Intracranial location is rare and may develop after hematogenous dissemination or contiguity. The invasive pseudotumoral form usually concerns immunodepressed patients. Invasive aspergillosis of the cavum is rare and its diagnosis is difficult. This infection can be fatal because of endocranial involvement and permeabilization of the blood-brain barrier, facilitating other neuromeningeal mycotic infections. We report the case of a 70-year-old diabetic and hypertensive female patient having presented with an invasive aspergillosis of the cavum and endocranial involvement complicated by Candida meningitis.

Furuncular myiasis: unusual case of African Dermatobia hominis.

Human cutaneous myiasis is a common disease in endemic tropical zones. Increased international travel has produced increases in imported cases. We present an unusual patient with myiasis infestation of the leg caused by Dermatobia hominis, which manifested after returning from the Democratic Republic of Congo. This particular infestation has not been reported in Morocco prior to this case. Furuncular cutaneous miyasis must be considered when travellers exhibit draining nodules. Medical treatment consists of occlusion of the furuncular punctum with vaseline to stimulate extrusion of the larva or surgical debridement under local anesthesia.

[Synthesis, chemical and toxicological study of a new benzimidazol derivative]. / Synthèse, étude chimique et toxicologique d'un nouveau dérivé benzimidazole.

Hydatidosis is a cosmopolitan parasitic disease that remains a real public health problem in highly endemic countries. Surgery is the mainstay treatment, but with significant morbidity and mortality. In addition, contraindications for surgery emphasize the importance of developing effective medications. Currently, albendazole is the main anti-hydatid agent used worldwide. It has proven efficacy but limited bioavailability due to weak absorption. In order to improve the bioavailability of this molecule we synthesized an ester of albendazole, which exhibits a totally modified solubility compared with the princeps compound. This synthesis was achieved with an output of 75%. The structure of the synthetic product was established by IR spectrometry and by proton nuclear magnetic resonance. A careful toxicity study revealed that this product has little toxicity when administered intraperitoneally and orally in mice, with a lethal dose 50 of 2,500 mg/kg per os and 2,250 mg/kg intraperitoneally, values comparable to those of albendazole. This in vitro parasitological study demonstrated that the chemical changes introduced on the albendazole molecule had no effect on its antiparasitic activity.

Successful treatment of disseminated Geotrichum capitatum infection with a combination of caspofungin and voriconazole in an immunocompromised patient.

Disseminated Geotrichum capitatum infection is uncommon, and has been reported exclusively in immunocompromised patients. The prognosis is poor with a mortality rate of approximately 50-75%. We report a case of disseminated G. capitatum infection in a severely neutropenic patient who was receiving chemotherapy for acute myeloblastic leukaemia. G. capitatum was isolated from blood cultures, skin lesions, bronchoalveolar lavage fluid, throat swabs and stools. The infection was successfully cured with a combination of voriconazole and caspofungin.

[Congenital cutaneous candidiasis: a case report and review]. / La candidose cutanée congenitale: a propos d'une observation et revue de la littérature.

The aim of this article is to report a case of congenital cutaneous candidiasis (CCC). We describe the clinical features and emphasize the role of laboratory testings to assess diagnosis in the newborn and to prevent this condition by screening vaginal candidiasis in pregnant women. A full-term, 3500-g male was born by spontaneous vaginal delivery to a 30-year-old healthy woman. On physical examination, he was a well-developed, vigorous newborn. Since the first hours of his life he presented erythematous maculae diffusely distributed on the skin and pustules overlying areas of confluent macular erythema on his trunk and extremities. The palms and soles were not affected. Neither oral thrush nor peri-anal lesions have been observed. The rest of the physical examination was normal. Microscopic examination of skin scrapings showed the presence of many yeasts and the culture permitted the identification of a strain of Candida albicans. Precocity and extent of the cutaneous signs attest a congenital cutaneous candidiasis and eliminate the other skin diseases of similar clinical symptoms. Topical antifungal therapy (econazole) was given and the cutaneous lesions disappeared after 20 days. CCC appears to be acquired in utero by the ascension of organisms from an infected vagina into the uterine cavity. This condition is preventable with systematic screening and treatment of vulvo-vaginitis due to Candida albicans in pregnant women, The important role played by the laboratory of mycology remains essential.