Increased CD1D polymorphism: identification of two novel alleles, CD1D*03 and *04, in individuals from Morocco.

Two novel CD1D alleles were identified in unrelated individuals from Morocco. They differ each from the common CD1D*01 allele by one nucleotide substitution in exon 2 resulting in one amino acid change in the G-ALPHA1-LIKE domain. According to the IMGT unique numbering for G domain, CD1D*03 has one nucleotide transition c136 > t in codon 46, with an arginine-to-cysteine amino acid change (R46 > C) in the D-STRAND, whereas CD1D*04 has one transition c98 > t in codon 33, with a threonine-to-methionine amino acid change (T33 > M) in the C-STRAND. This suggests that CD1D is more polymorphic than previously assumed.

Qualitative study of perceived causes of tuberculosis treatment default among health care workers in Morocco.

SETTING: In Morocco, tuberculosis (TB) treatment default is increasing in some urban areas. OBJECTIVE: To provide a detailed description of factors that contribute to patient default and solutions from the point of view of health care professionals who participate in TB care. DESIGN: In-depth interviews were conducted with 62 physicians and nurses at nine regional public pulmonary clinics and local health clinics. RESULTS: Participants had a median of 24 years of experience in health care. Treatment default was seen as a result of multilevel factors related to the patient (lack of means, being a migrant worker, distance to treatment site, poor understanding of treatment, drug use, mental illness), medical team (high patient load, low motivation, lack of resources for tracking defaulters), treatment organization (poor communication between treatment sites, no systematic strategy for patient education or tracking, incomplete record keeping), and health care system and society. Tailored recommendations for low- and higher-cost interventions are provided. CONCLUSIONS: Interventions to enhance TB treatment completion should take into account the local context and multilevel factors that contribute to default. Qualitative studies involving health care workers directly involved in TB care can be powerful tools to identify contributing factors and define strategies to help reduce treatment default.

Rapid screening and diagnosis of tuberculosis: a real challenge for the mycobacteriologist.

Tuberculosis (TB) is an infectious, devastating and contagious disease, which infects third of the global population worldwide with high rates of incidence in the developing countries, where the health care providers face a serious problem and a real challenge during their clinical practice for controlling and preventing the transmission of this illness. Indeed the first step of control is the correct diagnosis and the initiation of the drug treatment regimen at the early stage of infection, which mandate the rapidity of screening and the accuracy of laboratory testing. In this paper we aim to highlight the different actual techniques, regarding the rapid screening and diagnosis of tuberculosis.

Polyfunctional Mycobacterium tuberculosis-specific effector memory CD4+ T cells at sites of pleural TB.

Pleural tuberculosis (TB) is a common presentation of Mycobacterium tuberculosis (MTB) infection, and despite spontaneous resolution remains a strong risk factor for reactivation pulmonary TB in a majority of individuals. This study was undertaken to further understand the characteristics of immune cells at sites of pleural TB. A significant shift toward memory CD4+ T cells with an effector phenotype and away from naïve CD4+ T cells in pleural fluid as compared to blood mononuclear cells was found. These data suggest that effector T cells are capable of migrating to sites of active TB infection and/or the differentiation to effector phenotype T cells in situ is highly amplified. Using multi-parameter flow cytometry analysis, a significant portion of MTB-specific CD4+ T cells in the pleural space were polyfunctional demonstrating two, three or four simultaneous functions including IFN-gamma, IL-2, TNF-alpha, and or MIP-1 alpha production. A greater proportion of these polyfunctional cells were of effector memory rather than central memory phenotype. The role of these polyfunctional MTB-specific CD4+ T cells at sites of pleural TB requires further study.

Mycobacterial species as case-study of comparative genome analysis.

The genus Mycobacterium represents more than 120 species including important pathogens of human and cause major public health problems and illnesses. Further, with more than 100 genome sequences from this genus, comparative genome analysis can provide new insights for better understanding the evolutionary events of these species and improving drugs, vaccines, and diagnostics tools for controlling Mycobacterial diseases. In this present study we aim to outline a comparative genome analysis of fourteen Mycobacterial genomes: M. avium subsp. paratuberculosis K­10, M. bovis AF2122/97, M. bovis BCG str. Pasteur 1173P2, M. leprae Br4923, M. marinum M, M. sp. KMS, M. sp. MCS, M. tuberculosis CDC1551, M. tuberculosis F11, M. tuberculosis H37Ra, M. tuberculosis H37Rv, M. tuberculosis KZN 1435 , M. ulcerans Agy99,and M. vanbaalenii PYR­1, For this purpose a comparison has been done based on their length of genomes, GC content, number of genes in different data bases (Genbank, Refseq, and Prodigal). The BLAST matrix of these genomes has been figured to give a lot of information about the similarity between species in a simple scheme. As a result of multiple genome analysis, the pan and core genome have been defined for twelve Mycobacterial species. We have also introduced the genome atlas of the reference strain M. tuberculosis H37Rv which can give a good overview of this genome. And for examining the phylogenetic relationships among these bacteria, a phylogenic tree has been constructed from 16S rRNA gene for tuberculosis and non tuberculosis Mycobacteria to understand the evolutionary events of these species.

Mapping malaria transmission risk in northern morocco using entomological and environmental data.

Malaria resurgence risk in Morocco depends, among other factors, on environmental changes as well as the introduction of parasite carriers. The aim of this paper is to analyze the receptivity of the Loukkos area, large wetlands in Northern Morocco, to quantify and to map malaria transmission risk in this region using biological and environmental data. This risk was assessed on entomological risk basis and was mapped using environmental markers derived from satellite imagery. Maps showing spatial and temporal variations of entomological risk for Plasmodium vivax and P. falciparum were produced. Results showed this risk to be highly seasonal and much higher in rice fields than in swamps. This risk is lower for Afrotropical P. falciparum strains because of the low infectivity of Anopheles labranchiae, principal malaria vector in Morocco. However, it is very high for P. vivax mainly during summer corresponding to the rice cultivation period. Although the entomological risk is high in Loukkos region, malaria resurgence risk remains very low, because of the low vulnerability of the area.

Seroprevalence of hepatitis B and C among barbers and their clients in the Rabat region of Morocco.

A cross-sectional seroepidemiological study was conducted in the Rabat-Salé-Zemmour-Zaër region of Morocco in 2007 among 267 barbers and 529 clients, all men with no history of hepatitis B (HBV) vaccination. The overall prevalence of HBV seropositivity was 28.1% in barbers and 25.1% in clients; 1.9% and 1.7% respectively had active HBV (HBsAg positive). Risk factors for HBV included older age, low educational level, urban living, being married, history of transfusion, lack of current heterosexual relationship and liver-associated symptoms. Observations showed that HBV seropositivity was lower in clean barbershops and those using alum as an antispetic. The rate of PCR-confirmed hepatitis C virus (HCV) was only 1.1% and 1.3% in barbers and clients respectively, and was associated with increased age, drug use, history of surgery and symptoms of liver disease. Less than 1% of barbers were aware of HBV or HCV as causative agents of liver disease or jaundice.

Seroprevalence of hepatitis B and C among barbers and their clients in the Rabat region of Morocco

A cross-sectional seroepidemiological study was conducted in the Rabat-Sale-Zemmour-Zaer region of Morocco in 2007 among 267 barbers and 529 clients, all men with no history of hepatitis B [HBV] vaccination. The overall prevalence of HBV seropositivity was 28.1% in barbers and 25.1% in clients; 1.9% and 1.7% respectively had active HBV [HBsAg positive]. Risk factors for HBV included older age, low educational level, urban living, being married, history of transfusion, lack of current heterosexual relationship and liver-associated symptoms. Observations showed that HBV seropositivity was lower in clean barbershops and those using alum as an antispetic. The rate of PCR-confirmed hepatitis C virus [HCV] was only 1.1% and 1.3% in barbers and clients respectively, and was associated with increased age, drug use, history of surgery and symptoms of liver disease. Less than 1% of barbers were aware of HBV or HCV as causative agents of liver disease or jaundice

Correlation between genetic HLA class I and II polymorphisms and anthropological aspects in the Chaouya population from Morocco (Arabic speaking).

The aim of this study was to provide genetic and anthropological information on the Chaouya (CH), an Arabic-speaking population living in West Morocco, Atlantic coast (Settat). In 98 unrelated healthy CH volunteers, we first investigated the human leukocyte antigen (HLA) class I and II allele polymorphisms using a sequence-based typing method and examined haplotypes and relatedness of this group to other African and Mediterranean populations. The study showed the close relatedness with Tunisian population and other North Africans, together with a strong influence of various immigrations, mainly Spaniards, French, and Portuguese, as expected. Nevertheless, analysis of class II allele frequencies (afs) showed that Oromo and Amhara Ethiopian groups cluster together with the Berbers and other North Africans, confirming the relationship between these populations (Afro-Asiatic linguistic group, Hamites). South and sub-Saharan Africans cluster separately at a great distance from CH, except the sub-Saharan Bantu population from Congo Kinshasa, which shows a relatively close genetic relationship ascribable to the effect of a diversifying selection. On the other hand, considering HLA class I afs analyses, it was noteworthy that CH grouped together with sub-Saharans, showing a close genetic distance mainly with Ugandas and Kenians Luo.

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.

Molecular characterisation of rifampicin-resistant Mycobacterium tuberculosis strains from Morocco.

Mutations in the rpoB gene associated with rifampicin (RMP) resistance were studied in 47 RMP-resistant and 147 RMP-susceptible clinical strains of Mycobacterium tuberculosis from Morocco using probe-based assay and DNA sequencing. RMP-resistant mutations were identified in 85% of RMP-resistant isolates. No mutations were observed among the 147 RMP-susceptible strains. Sequence analysis identified 10 alleles, including two deletions not previously reported. Nucleotide changes at codons 531, 526 and 516 were the most prominent, accounting for 74.4% of our RMP-resistant strains. These results demonstrate that resistance genotyping at these codons would be a good marker for the rapid detection of RMP resistance.

Rubella seroprevalence among women aged 15-39 years in Morocco.

This study was designed to determine the age-specific rubella seroprevalence in women of childbearing age in Morocco and to contribute to the development of a rubella vaccination strategy in the country. Of 967 women aged 15-39 years tested in 2000, 161 (16.6%) were susceptible to rubella based on absence of IgG antibodies. A significantly higher rate of susceptibility among women aged 15-19 years was observed (29.3%) compared with age 35-39 years (8.3%). An estimated 77,562 live births occur annually to rubella-susceptible women. No statistical difference in seroprevalence was seen between women in rural and urban areas (81.5% and 85.0% respectively). A substantial risk of rubella infection exists for Moroccan women of childbearing age.

Evaluation of a multi-antigen test based on B-cell epitope peptides for the serodiagnosis of pulmonary tuberculosis.

SETTING: Two sample panels: 1) 20 pulmonary tuberculosis (PTB) patients and 10 healthy subjects from a country with a low incidence of TB (Italy); and 2) 47 PTB patients and 26 healthy subjects from a country with a high incidence of TB (Morocco). OBJECTIVE: To identify a combination of Mycobacterium tuberculosis peptides useful for the serodiagnosis of active PTB. METHODS: Fifty-seven B-cell epitope peptides of M. tuberculosis were evaluated by immunoenzymatic assay and the data were analysed using logistic regression analysis and the random forest method. RESULTS: The best discriminating peptide between PTB patients and healthy subjects from the sample of the low TB incidence country was the 23 amino acid peptide of the Rv3878 protein. The sensitivity and specificity were respectively 65% and 100%. The same peptide had a sensitivity and specificity of respectively 47% and 100% for the sample from the high TB incidence country. The best combination of peptides was a pool of nine peptides which had a sensitivity of 70.2% and a specificity of 100% in the high TB incidence country. CONCLUSIONS: The 9-peptide pool can be useful in identifying patients with active PTB.

[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.

Rubella seroprevalence among women aged 15-39 years in Morocco

This study was designed to determine the age-specific rubella seroprevalence in women of childbearing age in Morocco and to contribute to the development of a rubella vaccination strategy in the country. Of 967 women aged 15-39 years tested in 2000, 161 [16.6%] were susceptible to rubella based on absence of IgG antibodies. A significantly higher rate of susceptibility among women aged 15-19 years was observed [29.3%] compared with age 35-39 years [8.3%]. An estimated 77 562 live births occur annually to rubella-susceptible women. No statistical difference in seroprevalence was seen between women in rural and urban areas [81.5% and 85.0% respectively]. A substantial risk of rubella infection exists for Moroccan women of childbearing age

Hepatitis B in Moroccan health care workers.

AIM: To evaluate knowledge and perception of hepatitis B, including prevention, among Moroccan health care workers (HCWs) and to estimate seroprevalence of hepatitis B and vaccine coverage (VC). METHODS: Four hundred and twenty HCWs were randomly selected and stratified by site: 120 in Rabat, 140 in Taza and 160 in Témara-Skhirat. The study included an anonymous questionnaire about knowledge of hepatitis B and its prevention and a serological survey. Oral statements and vaccine registers were used to analyse the VC of the HCWs. Serological testing and VC were analysed according to the occupational exposure. RESULTS: Participation rates in the questionnaire and serological tests were 68% (285/420) and 66% (276/420), respectively. Fifteen (5%) HCWs had a history of hepatitis B. All HCWs considered that hepatitis B virus (HBV) infection may be acquired through blood exposure. Vaccination was acknowledged as a necessary means against HBV transmission by 276 (98%) HCWs. Forty-two per cent HCWs had no HBV serological markers. The prevalence of hepatitis B surface antigen was 1%. The mean prevalence of hepatitis B core antibody (anti-HBc) was 28% and was significantly higher (P < 0.05) among nursing auxiliaries (57%), nurses (30%), medical physicians (31%) and midwives (25%) than among laboratory technicians (13%). According to the vaccination registers (available in two sites), VC (> or =3 doses) was 55%. VC was 75% among midwives, 61% among nurses, 53% among nursing auxiliaries and 38% among medical staff. Of the fully vaccinated HCWs without anti-HBc, 51% had serological evidence of protection. CONCLUSION: HBV vaccines should be more readily available for Moroccan HCWs by reinforcing current vaccination programmes.

[Extension to the north of Morocco of the distribution area of Anopheles (Cellia) d'thali Patton, 1905]. / Extension vers le nord du Maroc de l'aire de distribution d'Anopheles (Cellia) d'thali Patton, 1905.

Anopheles (cellia) d'thali is generally classified as a mosquito of arid areas in the South and East Morocco. The northernmost station of this species at present in Morocco is the Moulouya valley. However we found An. d'thali during entomological investigations in the north of the country in the subhumid area of Chefchaouen. In Morocco, An. d'thali is therefore no longer a strictly desert species.

[Assessment of malaria resurgence risk in Morocco. Study of the vectorial capacity of Anopheles labranchiae in a rice cultivation area in the north of the country]. / Risque de réémergence du paludisme au Maroc. Etude de la capacité vectorielle d'Anopheles labranchiae dans une zone rizicole au nord du pays.

To assess the malaria reintroduction risk in Morocco, we analyzed the malariogenic potential of a rice cultivation area in the north of the country. Our results showed that the receptivity of this area is very high during all the period of the rice cultivation, from May to October, the vectorial capacity of An. labranchiae, malaria vector in Morocco, is considerably high during the summer which corresponds to the rice cultivation period. The risk of autochthonous malaria resumption is important because of the possible presence of gametocytes carriers in the last malaria focus which is bordering the study area. The risk of a tropical malaria introduction is unimportant seen the low vulnerability of the area and the uncertain competence of its vectors considered. However, this risk must be considered with a more attention.

[Diagnosis of pulmonary tuberculosis: evaluation of the TB IgA EIA assay in Morocco]. / Diagnostic de la tuberculose pulmonaire: evaluation du test "TB IgA EIA" au Maroc.

We analysed 2 evaluation lots of the TB IgA EIA test in pulmonary tuberculosis patients (TBp). Sera were obtained from 345 TBp, 18 healthy subjects (HS), 28 subjects in contact with tuberculous patients (CS) and 16 non-tuberculous lung disease patients (N-TB) for the first evaluation lots and 302 TBp, 60 HS, 21 CS and 18 N-TB for the second. IgA titres against p-90 antigen with the second evaluation lot were significantly higher than the first evaluation lot. With the second evaluation lots, the sensitivity was 78.8% whereas with the first evaluation lot, the sensitivity was 75.9%. Specificity for the first and second evaluation lots was 50% and 70.7% respectively. The sensitivity of this test is still not satisfactory to establish pulmonary tuberculosis diagnosis.