[A skin ulcer infection due to Rhodotorula mucilaginosa in an immunocompromised child]. / Une ulcération cutanée due à Rhodotorula mucilaginosa chez un enfant immunodéprimé.

Human cutaneous infections due to Rhodotorula species as an emerged pathogens yeasts are rarely reported, particularly in skin folds, with the ability to infect immunocompromised as well as immunocompetent patient. In present case, we describe a fungal cutaneous infection due to Rhodotorula mucilaginosa in immunocompromised child, the patient has been diagnosed with retinoblastoma; the diagnosis was established by the cytological and clinical examination. However, the cytological examination found fungal forms. The diagnosis relies on the microbiological analysis of clinical samples but the interpretation of a positive culture should be part of and over all analysis that integrate clinical symptoms and risk factors. Most of cases of infection due to Rhodotorula were associated with central venous catheter in patients who were receiving immunosuppressors and cyotoxic drugs. The antifungal susceptibility testing was done; a fluconazol and ketoconazol showed susceptibles. The patient was treated by combinate antifungal therapy and empirical antimicrobial regimen for prophylaxis.

A comparison of human metapneumovirus and respiratory syncytial virus WHO-defined severe pneumonia in Moroccan children.

Acute respiratory infections remain the principal cause of morbidity and mortality in Moroccan children. Besides bacterial infections, respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) are prominent among other viruses due to their high prevalence and association with severe clinical episodes. We aimed to describe and compare RSV- and hMPV-associated cases of WHO-defined severe pneumonia in a paediatric population admitted to Morocco's reference hospital. Children aged 2-59 months admitted to the Hôpital d'Enfants de Rabat, Morocco meeting WHO-defined severe pneumonia criteria were recruited during 14 months and thoroughly investigated to ascertain a definitive diagnosis. Viral prevalence of RSV, hMPV and other viruses causing respiratory symptoms was investigated in nasopharyngeal aspirate samples through the use of molecular methods. Of the 683 children recruited and included in the final analysis, 61/683 (8·9%) and 124/683 (18·2%) were infected with hMPV and RSV, respectively. Besides a borderline significant tendency for higher age in hMPV cases, patients infected with either of the viruses behaved similarly in terms of demographics, patient history, past morbidity and comorbidity, vaccination history, socioeconomic background and family environment. Clinical presentation on arrival was also similar for both viruses, but hMPV cases were associated with more severity than RSV cases, had a higher risk of intensive care need, and received antibiotic treatment more frequently. RSV and hMPV are common and potentially life-threatening causes of WHO-defined pneumonia in Moroccan children. Both viruses show indistinctive clinical symptomatology, but in Moroccan children, hMPV was associated with a more severe evolution.

[Severe macrophage activation syndrome following visceral leishmaniasis in a child]. / Syndrome d'activation macrophagique sévère secondaire à une leishmaniose viscérale infantile.

Visceral leishmaniasis (VL) is a parasitic disease that is a public health problem in Morocco and is one of the frequent infectious causes of macrophage activation syndrome (MAS). The combination of clinical and laboratory criteria, even very unspecific, make it possible to diagnose MAS, but a definitive diagnosis requires cytological examination. Rapid treatment is essential. The outcome was favorable.

[Iliofemoral cutaneous mucormycosis with endopelvic extension in an immunocompetent child]. / Mucormycose cutanée ilio-fémorale avec extension endo-pelvienne chez un enfant immunocompétent.

Mucormycosis is a rare opportunistic fungal infection with clinical polymorphism and is rapidly extensive and destructive. It is caused by fungi of the mucorales group in the environment and generally arises in the context of immunosuppression. Often difficult and late, diagnosis is based on mycological and histological examination. We report the case of a 10-year-old patient admitted for a pruritic erythematous scaly eruption located in the right inguinal area associated with satellite lymphadenopathy and lymphedema of the right lower limb. The histological study of the cutaneous biopsy revealed a granulomatous reaction with filaments. The mycological examination of the collection of the cutaneous lesion showed mucorales filaments and a stump of Absidia corymbifera was isolated. Abdomino-pelvic CT showed muscular extension with vascular and ureteral englobement. The diagnosis of cutaneous mucormycosis was made. Immunological investigations were normal. Treatment included itraconazole for 3months followed by IV amphotericin B for 1month, with favorable clinical and radiological progression. Mucormycosis is an uncommon fungal infection whose cutaneous localization is rare. It occurs exceptionally in immunocompetent patients and is clinically manifested by a vesicular and pustular rash progressing to ulceration. The diagnosis is confirmed by mycological and histological studies. Treatment consists of antifungal therapy associated with surgical excision of necrotic and infected tissue.

[The subcutaneous mucormycosis due to Lichtheimia corymbifera: A case report in an immunocompetent child]. / Les mucormycoses sous-cutanées àLichtheimia corymbifera : à propos d'un cas chez un enfant immunocompétent.

Mucormycosis due to Lichtheimia (ex Absidia) corymbifera is a rare fungal infection, occurring most often in an environment of immune deficiency, rarely in an immunocompetent patient. It comes in different clinical forms, frequently misleading, hence the interest of a pathological and mycological examination that allows the diagnosis of certainty. The management of this condition should be introduced early because it affects the functional prognosis of the patient. In this study, the authors report a case of mucormycosis in a 10-year-old child, and with clinical immunocompetent less severe than the cases reported in the literature.

[Epidemic of nosocomial infection by rotavirus in a neonatology service]. / Epidémie d'infection nosocomiale à rotavirus au sein d'un service de néonatologie.

The goal of work is to establish a clinical descriptive analysis of the epidemic of nosocomial rotavirus occurred in the Neonatal Unit of the Hospital's Child Rabat for a winter period. We systematically collected all the patients of the service right from the first case of rotavirus nosocomial infection. Patients with a stay of less than 48 hours of hospitalization were excluded. We have established operating sheets for all positive cases, with the term, birth weight, postnatal age and weight during the sampling, clinical symptoms, treatment, and the evolution. Out of the 36 cases analyzed (where 26 preterm and 10 term neonates), 12 samples were positive for rotavirus, so one third of patients. The patients with positive samples were in 75% symptomatic cases. The clinical signs were represented in term newborns with stool weight with stagnant fluid in 2 cases and weight loss in one case and in premature infants with mucous stools with abdominal distension in 2/3 of cases, and fluid and stool dehydration in 1/3 of cases. A very low rate of breastfeeding (17%) was noted among all newborns service in this epidemic. We performed the isolation of positive patients, with a strengthening of hygiene measures. In addition, infants were started on symptomatic treatment with careful clinical monitoring. Evolution was complicated by necrotizing enterocolitis in 3 cases of preterm infants.

[Human rhinomyiasis due to Oestrus ovis: case report in Morocco]. / Rhino-myiase humaine a Oestrus ovis: une observation au Maroc.

The purpose of this report is to describe a case of human nasal myiasis caused by Oestrus ovis diagnosed in our laboratory in Morocco. Oestrus ovis is an obligate parasite of nasal cavities and sinuses. It is usually found in sheep and goats in the Mediterranean basin. Oestrosis is a rare finding in man.

[Epidemiology of tinea capitis in outpatients at the Children's Hospital in Rabat (Morocco)]. / Épidémiologie des teignes du cuir chevelu chez les consultants externes à l'hôpital d'enfants de Rabat (Maroc).

OBJECTIVE: The aims of this report on results of a retrospective study were to identify the incidence of this pathology among outpatients at the Children's Hospital in Rabat, Morocco, the species involved, their respective prevalence, and the influence of the age and sex of the patient. PATIENTS AND METHODS: Between 1993 and 2007, a mycological examination was performed on 2962 patients in the dermatology service of Ibn Sina University Health Center in Rabat. Mean patient age was 35 (ages ranged from three months to 70 years). RESULTS: Direct microscopic examination was made of all the patients' hair, followed by culture on Sabouraud medium leading to the identification of scalp ringworm in 1299 patients. The age group most affected was children under ten years of age (50% of the cases), mostly boys (M: F sex-ratio 1:14). The majority of cases of ringworm in our study were caused by Trichophyton mentagrophytes with 992 cases (76.4%), followed by Microsporum canis with 174 cases (13.4%). Inflammatory ringworm was identified in 32 patients (2.5%) and 30 cases of honeycomb ringworm (tinea favosa) (2.3%). Trichophyton violaceum was more frequent among girls and M. canis was more frequent among boys. Analysis of the incidence of the different species over the years revealed a clear decrease in case of tinea favosa, a decreasing trend for T. violaceum and a significant recrudescence of M. canis. CONCLUSION: T. violaceum continues to be the most common species of scalp ringworm in Morocco, despite a significant increase in M. canis. Tinea favosa has been practically eradicated.

[Primitive aspergillosis of the posterior cerebral fossa in immunocompetent patient]. / Aspergillose primitive de la fosse cérébrale postérieure chez un patient immunocompétent.

Cerebral aspergillosis arises in the great majority of cases during an invasive aspergillosis with hematogene scattering from the lung hurts. The cerebral, not rare location is one of the worse criteria forecast during the invasive aspergillosis. We report the case of patient who was hospitalized in the neurosurgery department for syndrome of increased intracranial pressure, hemiparesis and cerebellar syndrome in febrile context. The radiological exploration objectified a collection of the posterior fossa. A stereotactic biopsy was performed. It collected fragments biopsy and pus. The pathological and microbiological analysis allowed the identification of Aspergillus fumigatus. The originality of this observation comes from the rare location in the posterior fossa of aspergillosis and because the patient is immunocompetent and no primary location is found. The patient presents however a viral hepatitis B of fortuitous discovery. He is put under treatment by amphotericin B. The evolution is marked by meningitis comment-diversion. Antibiotics are prescribed, and then the patient is operated for total ablation of the tumor. He dies following an osmolar coma associated with thrombopenia and a secondary renal insufficiency due to his treatment by the amphotericin B.

[Human auricular myiasis caused by Wohlfahrtia magnifica (Diptera: Sarcophagidae): about three observations in Morocco]. / Otomyiases humaines dues à Wohlfahrtia magnifica (Diptera: Sarcophagidae): à propos de trois observations au Maroc.

We report three cases of human otomyiasis observed in rural Moroccan children. Myiasis of external orifices usually occurs from neglected chronic lesions of the patients with poor personal hygiene. The parasitologic identification revealed Wohlfahrtia magnifica. Wohlfahrtiosis is common myiasis of sheep and goats in Mediterranean basin. Through this paper we underline the epidemiological, pathogenic, clinical and therapeutic aspects of this parasitosis.

[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.