HIDEA syndrome: A new case report highlighting similarities with ROHHAD syndrome.

Context: ROHHAD syndrome presents a significant resemblance to HIDEA syndrome. The latter is caused by biallelic loss-of-function variants in the P4HTM gene and encompasses hypotonia, intellectual disabilities, eye abnormalities, hypoventilation, and dysautonomia. We report the first patient identified with HIDEA syndrome from our ROHHAD cohort. Clinical case: Our patient was a 21-month-old girl who had a history of severe respiratory infections requiring intensive care, hypotonia, abnormal eye movements, and rapid weight gain. Polysomnography identified severe central hypoventilation. During her follow-up, a significant psychomotor delay and the absence of language were gradually observed. The prolactin levels were initially increased. Hypothermia was reported at 4 years. Exome sequencing identified a new homozygous truncating P4HTM variant. Discussion: Our patient met the diagnosis criteria for ROHHAD, which included rapid weight gain, central hypoventilation appearing after 1.5 years of age, hyperprolactinemia suggesting hypothalamic dysfunction, and autonomic dysfunction manifesting as strabismus and hypothermia. However, she also presented with severe neurodevelopmental delay, which is not a classic feature of ROHHAD syndrome. HIDEA syndrome presents similarities with ROHHAD, including hypoventilation, obesity, and dysautonomia. To date, only 14% of endocrinological disturbances have been reported in HIDEA patients. Better delineation of both syndromes is required to investigate the eventual involvement of P4HTM, a regulator of calcium dynamics and gliotransmission, in ROHHAD patients. Conclusion: In the case of clinical evidence of ROHHAD in a child with abnormal neurological development or eye abnormalities, we suggest that the P4HTM gene be systematically interrogated in addition to the analysis of the PHOX2B gene. A better delineation of the natural history of HIDEA is required to allow further comparisons between features of HIDEA and ROHHAD. The clinical similarities could potentially orient some molecular hypotheses in the field of ROHHAD research.

[Treatment of tracheo(broncho)malacia in children]. / Comment je traite la trachéo(broncho)malacie de l'enfant ?

Tracheomalacia (TM) is characterized by tracheal collapse due to an intrinsic anomaly resulting in a lack of rigidity of the cartilaginous rings and/or the posterior membrane during expiration, coughing or crying. It may also be secondary to external compression or acquired during endobronchial diseases. TM is commonly associated with other syndromes or airway abnormalities. Tracheomalacia can be localized or diffused and if the main bronchi are involved, the term of tracheobronchomalacia (TBM) is used. The most common symptoms include expiratory stridor, barking cough and recurrent respiratory tract infections. If tracheal weakness is severe, Acute Life Threating Events (ALTE) or Brief Resolved Unexplained Event (BRUE) can occur. While mild forms usually do not require any treatment, severe TBM may require medical and/or surgical management. Amongst several possible treatments, including tracheostomy, noninvasive ventilation and airway stenting, the pexy surgical approach (posterior, anterior tracheopexy or aortopexy) is currently the favoured option.

La trachéomalacie (TM) est caractérisée par un collapsus trachéal plus ou moins important durant l'expiration, lors des efforts de toux ou des pleurs. Elle peut être due à une anomalie intrinsèque, par manque de rigidité des anneaux cartilagineux et/ou de la membrane postérieure. Elle peut aussi avoir une origine extrinsèque, soit secondaire à une compression externe, soit acquise dans le cadre de pathologies endo-bronchiques. Elle peut enfin être associée à certains syndromes ou malformations des voies respiratoires. La TM peut être localisée ou généralisée, et si les bronches principales sont atteintes, on parlera de trachéobronchomalacie (TBM). Les symptômes les plus courants sont : un stridor expiratoire, une toux aboyante, et des infections respiratoires récurrentes. Dans les cas les plus sévères, des événements menaçant la vie de l'enfant (Acute Life-Threatening Event «ALTE¼ ou Brief Resolved Unexplained Event «BRUE¼) peuvent survenir. Alors que les formes légères ne requièrent généralement pas de traitement, la TBM sévère peut nécessiter une prise en charge médicale et/ou chirurgicale. Parmi les divers choix thérapeutiques, incluant notamment la trachéostomie, la ventilation non invasive et les stents trachéaux, l'approche chirurgicale par pexie (aortopexie, trachéopexie postérieure ou antérieure) est actuellement l'option favorite.

Diffuse alveolar hemorrhage in infants: Report of five cases.

Diffuse alveolar hemorrhage (DAH) is a rare life-threatening condition in children. In this entity, the bleeding originates from the pulmonary microvasculature as a result of microvascular damage leading to blood leakage into the alveolar spaces. DAH can occur as an isolated medical entity or may be associated with other organ system injury or dysfunction. The classic triad of symptoms includes hemoptysis, anemia and diffuse pulmonary infiltrates. Hemoptysis is the usual presenting symptom but is not constant. A variety of diseases is associated with the development of DAH. Current classification organize the etiologies of diffuse alveolar hemorrhage based on the presence of severe immune disorders (such as systemic vasculitis and collagenosis) or non-immunodeficiency disorders (with an identified cardiac or non-cardiac origin, or idiopathic). The five cases of DAH presented in this study were all diagnosed in full-term infants, four males and one female, with normal neonatal adaptation and without family history of notable diseases. In all cases the diagnosis was made between the age of three and eighteen weeks-old. Moreover, all five patients, at the time of diagnosis, presented with hemoptysis, mild or severe dyspnea, anemia and abnormal chest X-rays. Consequently, the diagnosis of DAH was strongly suspected and, eventually, confirmed by bronchoscopy. Additional laboratory tests, as well as selected serologic and radiographic studies were performed in order to identify a specific etiology. The final diagnoses reflect a variety of causes: infections, idiopathic pulmonary hemosiderosis, accidental suffocation and Heiner syndrome. Treatment included oral corticosteroids except from one patient that received antimicrobial therapy.

[Right ventricular function after a first episode of pulmonary embolism: Contribution of longitudinal 2D strain]. / Fonction ventriculaire droite après un premier épisode d'embolie pulmonaire : apport du strain 2D.

BACKGROUND: Analysis of right ventricular (RV) function during the acute phase of pulmonary embolism (PE) was widely reported in the literature. However, few studies analysed its function long term after the acute phase. Our aim was to evaluate the RV function long term after a first episode of PE. METHODS: In this study, we compared echocardiographic parameters of right ventricular function in 25 patients with a first episode of non-severe PE for more than six months with 25 healthy controls subject. RESULTS: In the study of RV function, we noted that the mean values of the standard parameters were significantly lower in the EP group compared to the control group but their values remained within the normal range. The global RV longitudinal strain had a mean value lower than the control group statistically significant (-21±4,8% vs. -25±2,4%; P=0,28). The longitudinal strain of the free wall of the RV was altered in the EP group, however, there was no significant difference between the EP group and the control group (-19,4±16% vs. -24±17%; P=0,28). CONCLUSION: This study has shown that there is a systolic dysfunction late after a first episode of PE and this despite the absence of the symptoms and pulmonary hypertension.

[Neonatal screening for cystic fibrosis : towards a national implementation in Belgium in 2019]. / Dépistage néonatal de la mucoviscidose : vers une implémentation nationale en Belgique en 2019.

Cystic fibrosis has in Belgium a prevalence of 1/2.850 births, with a median age at diagnosis of 7 months according to the latest data from the Belgian registry of 2015. In our country, the diagnosis of cystic fibrosis is always based on signs and symptoms of the disease. However, because the scientific literature has largely demonstrated the benefits of neonatal screening for cystic fibrosis, it will be implemented in Belgium before the end of 2019. The screening programme should be framed by strict quality criteria in order to obtain the best performance with the least possible inconvenience.

La mucoviscidose a une prévalence en Belgique de 1/2.850 naissances, avec un âge médian au diagnostic de 7 mois selon les dernières données du registre belge de 2015. Dans notre pays, le diagnostic de mucoviscidose est majoritairement basé sur les signes et les symptômes de la maladie. Toutefois, la littérature scientifique ayant largement démontré les avantages d'un dépistage néonatal de la mucoviscidose, celui-ci sera implémenté en Belgique avant la fin 2019. Il convient que le programme de dépistage soit encadré de critères de qualité stricts afin d'obtenir la meilleure performance, avec le moins d'inconvénients possibles.

[Bacteriology of acute exacerbations of chronic obstructive pulmonary disease in Tunisia]. / Bactériologie des exacerbations aiguës des bronchopneumopathies chroniques obstructives en Tunisie.

INTRODUCTION: The role of bacteria, including atypical organisms, in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) has been assessed in various ways in Tunisia. METHODS: This was a descriptive and analytical study of patients with a mean age of 68.3±10.5 years hospitalized for AECOPD. Bacteriological examination included a cytological sputum exam and serology for atypical organisms including Mycoplasma pneumoniae, Coxiella burnetii, Chlamydophila pneumoniae and Legionella pneumophila using standard techniques. RESULTS: Of the 240 patients enrolled, 175 sputum cultures (73%) were considered significant. Twenty-nine cultures were positive (16.5%) and 31 microorganisms were isolated of which the most frequent were P. aeruginosa (25.8%), K. pneumoniae (16.2%), H. influenzae (13%) and S. pneumoniae (9.7%). The prevalence of C. pneumoniae, M. pneumoniae and C. burnetii was 8.4%, 9% and 6.6%, respectively. No L. pneumophila infection was found. The Anthonisen criteria were associated with a positive culture (P=0.04). Almost half (40.9%) of the isolates were resistant to conventional first line antibiotics (43.7% to amoxicillin-clavulanic acid). CONCLUSIONS: Awareness of the low positivity of quantitative sputum bacteriology and the large percentage of resistant strains with a predominance of exclusively multi-resistant Pseudomonas should help in the management of patients with AECOPD.

Prevalence and risk factors of hepatitis B and C among hemodialysis patients in Tunisia.

OBJECTIVE: Hemodialysis patients are at increased risk of infection by hepatitis C and B viruses, which are significant causes of mortality and morbidity. Prevention of their transmission in hemodialysis units remains a challenge worldwide. We aimed to investigate the prevalence of these two infections and to explore major risk factors among patients on chronic hemodialysis. MATERIALS AND METHODS: We performed a cross-sectional study of 109 hemodialysis patients (mean duration of hemodialysis of seven years) between 2012 and 2014 in a Teaching Hospital of Monastir, Tunisia. Hepatitis B and C serological markers were searched for using a chemiluminescent assay. Genome detection was performed using a commercially available quantitative real-time PCR test. RESULTS: A total of 109 hemodialysis patients were enrolled (75 males and 34 females). Ages ranged from 21 to 81 years. Six (5.5%) of these 109 patients had HBV infection defined by a positive HBsAg in four (3.7%) patients and by a detectable DNA associated with an "isolated anti-HBc" profile in the remaining two patients. Hepatitis C was observed in eight patients (7.3%) and five of them had detectable RNA. Hemodialysis duration ˃5years was the main risk factor for hepatitis C infection (P=0.01; OR: 3.11; 95% CI [1.57-13.71]). CONCLUSION: Our findings confirm the downward trend of the prevalence of both hepatitis B and C infections among Tunisian hemodialysis patients. Hemodialysis duration remains the main risk factor for hepatitis C infection. Occult hepatitis B infection should be suspected and investigated, especially among patients with an "isolated anti-HBc" profile.

Prevalence of Chlamydophila pneumoniae and Mycoplasma pneumoniae IgM and IgG antibodies in Tunisian patients presenting with exacerbation of chronic obstructive pulmonary disease.

OBJECTIVE: We aimed to assess the prevalence of Chlamydophila pneumoniae and Mycoplasma pneumoniae acute infections, using serological testing, in patients admitted to the emergency department for acute exacerbations of chronic obstructive pulmonary disease (COPD). METHODS: We performed a prospective observational study of 100 consecutive patients. Serum specimens were collected at day 0 and day 15. C. pneumoniae and M. pneumoniae antibodies (IgM and IgG) were tested by commercial ELISA and immunofluorescence assay, respectively. RESULTS: We did not observe any acute M. pneumoniae infection; however, 11 patients (11%) showed a profile compatible with a recent C. pneumoniae infection (nine patients with specific IgM and two with an IgG antibody rise). Demographic and clinical parameters did not differ between patients with and without biological profile of recent C. pneumoniae infection. CONCLUSION: C. pneumoniae is a pathogen that requires specific antimicrobial treatment. Its detection must always be performed considering its prevalence in patients presenting with acute COPD exacerbations.

MGMT methylation assessment in glioblastoma: MS-MLPA versus human methylation 450K beadchip array and immunohistochemistry

Purpose: The MGMT gene encodes a DNA repair enzyme that counteracts with chemotherapy efficiency, specifically with alkylating agents such as temozolomide (TMZ). It is well established that MGMT methylation should be screened as a predictive marker for TMZ in glioblastoma, and we thus aimed to determine a reliable and practical diagnostic method of MGMT methylation detection. Patients and methods: 55 glioblastomas were investigated for MGMT methylation status using methylation-specific multiplexed ligation probe amplification (MS-MLPA), illumina human methylation 450K BeadChip array (HM450 K) analysis, and compared to MGMT protein expression by immunohistochemistry (IHC) staining. The methylation status of promoter, intron and all MGMT CpG targeted sites were separately correlated to patient’s survival. Results: In addition to MS-MLPA and 450 K concordance, our results showed significantly higher overall survival (OS) of patients receiving TMZ and presenting MGMT methylated promoter (mean OS = 21.5 months, p = 0.046). Including all glioblastoma cases and regardless of chemotherapy, MS-MLPA showed significant survival difference between MGMT methylated and unmethylated cases (mean OS = 13, p = 0.021). Conclusion: We concluded that in glioblastoma, MGMT promoter methylation predicts TMZ sensitivity. This current comparative analysis leads to consider that MS-MLPA is a valuable as HM450 K array for MGMT methylation status screening (AU)

No disponible

MGMT methylation assessment in glioblastoma: MS-MLPA versus human methylation 450K beadchip array and immunohistochemistry.

PURPOSE: The MGMT gene encodes a DNA repair enzyme that counteracts with chemotherapy efficiency, specifically with alkylating agents such as temozolomide (TMZ). It is well established that MGMT methylation should be screened as a predictive marker for TMZ in glioblastoma, and we thus aimed to determine a reliable and practical diagnostic method of MGMT methylation detection. PATIENTS AND METHODS: 55 glioblastomas were investigated for MGMT methylation status using methylation-specific multiplexed ligation probe amplification (MS-MLPA), illumina human methylation 450K BeadChip array (HM450 K) analysis, and compared to MGMT protein expression by immunohistochemistry (IHC) staining. The methylation status of promoter, intron and all MGMT CpG targeted sites were separately correlated to patient's survival. RESULTS: In addition to MS-MLPA and 450 K concordance, our results showed significantly higher overall survival (OS) of patients receiving TMZ and presenting MGMT methylated promoter (mean OS = 21.5 months, p = 0.046). Including all glioblastoma cases and regardless of chemotherapy, MS-MLPA showed significant survival difference between MGMT methylated and unmethylated cases (mean OS = 13, p = 0.021). CONCLUSION: We concluded that in glioblastoma, MGMT promoter methylation predicts TMZ sensitivity. This current comparative analysis leads to consider that MS-MLPA is a valuable as HM450 K array for MGMT methylation status screening.

Antibacterial and antibiofilm activities of Laurus nobilis L. essential oil against Staphylococcus aureus strains associated with oral infections.

BACKGROUND: Laurus nobilis L. is an aromatic herb with relevant medicinal properties due to its important chemical composition and its potential therapeutic effects. In this study, we investigate the chemical composition, the antibacterial and the antibiofilms activities of Tunisian L. nobilis L. essential oils against clinical Staphylococcus aureus strains. METHODS: The chemical composition of L. nobilis L. essential oils was analysed by Gas Chromatography-Mass Spectrometry (GC-MS). The antibacterial activity of L. nobilis L. essential oils was evaluated in vitro against oral S. aureus (n=21) strains using broth microdilution method. The antibiofilm activity was assessed via Crystal Violet staining and MTT assays. RESULTS: Our results revealed that GC-MS assay exhibited 1.8-Cineole, methyl eugenol and α-terpinyl acetate as the major compounds in the essential oils. Moreover, the essential oil from Sousse exhibited the best bactericidal activity (MICs values ranged from 3.91 to 15.62mgm-1). Furthermore, this oil showed a strong biofilm inhibition effect above 70%, from a low sub-inhibitory concentration (1/16×MIC). MTT assay revealed that both essential oils displayed an excellent antibiofilm activity with eradication percentages ranging from 79.6±2.27 to 95.2±0.56. CONCLUSION: Our finding demonstrated that L. nobilis L. essential oils are able to inhibit oral S. aureus strains with important antibiofilm efficacy. It could have a promising role in the prevention of oral diseases.

[Acquired bacterial meningitis in Monastir region, Tunisia (1999-2006): bacteriological aspects and susceptibility patterns]. / Lesméningites purulentes dans la région deMonastir, Tunisie (1999-2006): aspects bactériologiques et état de résistance aux antibiotiques.

The aim of this study was to analyze the distribution of bacteria responsible for purulent meningitis and the pattern of resistance of common species in the University Hospital of Monastir (Tunisia). All bacteriologically confirmed cases of bacterial meningitis were recorded between 1999 and 2006, and have been analyzed by classic bacterial methods advocate for meningitis. Two hundred fifty three strains have been isolated. The most frequent species were Streptococcus pneumoniae, Haemophilus influenzae, and Klebsiella pneumoniae, followed by Escherichia coli and Neisseria meningitides with 19.4, 13.8, 13.8, 7.1, and 6.3% of cases, respectively. Their distribution with regard to age was in accordance with literature data. The yearly distribution of these bacteria did not show any epidemic peak. Enterobacteriaceae and group B Streptococcus were the most frequently identified pathogens in neonatal meningitis. H. Influenzae was the predominant microorganism in children between three month and five years of age (36.3%), followed by S. Pneumoniae (28.8%). S. Pneumoniae was the predominant bacteria responsible for 47% of the cases over five years of age. 38.8% of S. Pneumoniae strains were less susceptible to penicillin. Resistance rates for amoxicillin and cefotaxime were 4.1%, respectively. Only one strain of N. meningitidis (6.2%) presented a decreased susceptibility to penicillin. 22.9% of H. Influenzae strains produced ß-lactamase. The resistance rates of Enterobacteriaceae to third generation cephalosporins were 25%. In our study, nosocomial meningitis have shown a rate of 24.4%. The most affected service was neurosurgery, pediatrics, and intensive care units. The increasing prevalence of pneumococci meningitis with reduced sensitivity to penicillin G strains isolated from meningitis makes adequate therapeutic management difficult.

Relationship between electropherotypes and VP7/VP4 genotypes of group A rotaviruses detected between 2000 and 2007 in Tunisian children.

BACKGROUND: Rotaviruses are the most frequent agents associated with diarrhoea in children worldwide. Analysis of mobility of the 11 segments of genomic RNA by polyacrylamide gel electrophoresis (PAGE) yields a pattern which is characteristic for a particular rotavirus isolate. The group A rotaviruses can be further characterized by analysis of VP7 and VP4 genes specificities, responsible for rotavirus classification into G and P genotypes, respectively. The aim of the present study was to detect a relationship between electropherotype pattern and molecular characteristics of the rotavirus strains. MATERIAL AND METHODS: Were analyzed 278 rotavirus-positive specimens by PAGE and G/P-genotyped by multiplex semi-nested RT-PCR. Pearson's correlation tests were used for statistical analysis. RESULTS: Twelve different electropherotypes were visualized, eight with a long profile (186 cases) and four with a short one (87 cases). Concerning VP7 types, G2 viral strains were found to be predominant and were detected in 91 specimens (32.7%). Strains with G1, G3, G4, G8 and G9 specificities were detected in 62 (22.3%), 82 (29.5%), 13 (4.7%), two (0.7%) and seven cases (2.5%), respectively. The results of VP4 genotyping showed a predominance of P[8] genotype which comprised half of the strains identified (139 cases, 50%). VP4 P[4], P[6] and P[11] were found in 83 (29.9%), 31 (11.1%) and 11 (4.0%) specimens, respectively. A high rate of mixed strains was also found (1.8% mixed electropherotypes, 7.6% G-mixed and 5% P-mixed strains). Electropherotype pattern of rotavirus strains was significantly correlated with VP7 genotype (p=0.018) and with VP4 genotype specificities (p<0.001).

[Evolution of group A Rotavirus strains circulating in Tunisia over a 3-year period (2005-2007)]. / Évolution des souches de Rotavirus du groupe A en circulation en Tunisie sur une période de trois ans (2005-2007).

BACKGROUND: Rotaviruses are the most frequent agents associated with diarrhoea in children worldwide. Analysis of mobility of the 11 segments of genomic RNA by polyacrylamide gel electrophoresis (PAGE) yields a pattern which is characteristic for a particular rotavirus isolate. The group A rotaviruses can be further characterized by analysis of VP7 and VP4 genes specificities, responsible for rotavirus classification into G and P genotypes, respectively. The aim of the present study was to determine the evolution of group A Rotavirus strains circulating in Tunisia over a 3-year period (2005-2007). MATERIAL AND METHODS: A total of 1503 stool samples collected from children less than five years old, consulting or hospitalised in Tunisia for diarrhoea between 2005 and 2007, were screened for the presence of group A Rotaviruses. Rotavirus-positive specimens were further analyzed by PAGE and G/P-genotyped by multiplex semi-nested RT-PCR. RESULTS: Rotaviruses were detected in 323 stool samples over 1503 (21 %). Long electropherotypes predominated in Tunisia during the whole period of study (N=158 vs N=82 short electropherotypes). VP7 genotyping showed the cocirculation of five different genotypes: G1, G2, G3, G4 and G9. VP4 typing detected four different P-genotypes: P[8], P[4], P[6] and P[11]. Rotavirus strains with G3P[8] specificity were predominating in Tunisia in 2005 and 2006, replaced by G2P[4] strains in 2007.

Clinical Features of Rotavirus Infections : Influence of Child Age on Clinical Manifestations

Objectifs : Decrire les caracteristiques cliniques des infections a Rotavirus et comparer les symptomes observes en fonction de l'age des enfants. Malades et methodes : Les dossiers cliniques de 278 enfants de moins de 5 ans infectes par le Rotavirus ont ete consultes retrospectivement. La presence d'antigenes de Rotavirus du groupe A dans les selles a ete detectee par la technique immunoenzymatique. Une correlation statistique entre les signes cliniques et l'age des enfants a ete recherchee au moyen des tests de correlation de Pearson. Resultats : Parmi les 278 enfants positifs a Rotavirus; 93;9ont presente une diarrhee; 79;1des vomissements; 71;6de la fievre; 37;4des signes respiratoires et 33;1des troubles neurologiques. Une rehydratation intraveineuse requise pour 59;7des enfants. D'une facon generale; la diarrhee (p = 0;001); les vomissements (p = 0;007); la fievre (p=0;045); les troubles respiratoires (p = 0;01) et la deshydratation (p 0;001) etaient significativement plus frequents chez les nourrissons de 1-24 mois par rapport aux autres enfants infectes. Conclusion : La severite du syndrome clinique induit par les infections a Rotavirus semble etre directement influencee par l'age de l'enfant. Il etait interessant de noter que les nourrissons de 1 a 5 mois ont presente des formes cliniques souvent aussi severes que ceux de 6 a 24 mois

[Phenotypic and genotypic (randomly amplified polymorphic DNA analysis and multiple-locus variable-number tandem-repeat analysis) charaterization of 96 clinical isolates of Pseudomonas aeruginosa in the F. Bourguiba hospital (Monastir, Tunisia)]. / Caractérisation phénotypique et génotypique (randomly amplified polymorphic DNA analysis et multiple-locus variable-number tandem-repeat analysis) de 96 isolats cliniques de Pseudomonas aeruginosa à l'hôpital F. Bourguiba (Monastir, Tunisie).

AIM OF THE STUDY: Phenotypic and genotypic characterization of 96 clinical isolates of Pseudomonas aeruginosa recovered in a Tunisian teaching hospital during a 16-month period. MATERIALS AND METHODS: All the isolates were characterized by serotyping, antimicrobial susceptibility typing and genotyping with randomly amplified polymorphic DNA (RAPD) analysis and multiple-locus variable-number tandem-repeat analysis (MLVA). RESULTS: Forty-one isolates out of 96 (43%) were recovered from two intensive care units (medical and chirurgical). Most of the isolates (48%) belonged to serotype O:11. Among the 13 antibiotypes, three multidrug resistant ones were mostly observed within the two intensive care units. Genotyping showed 83 RAPD types and 52 MLVA types. Isolates showing the same serotype could show different genotypes. A limited number of clusters was highlighted with MLVA typing, of which an outbreak of nine cases within the surgical intensive care unit. CONCLUSION: Except this outbreak of nine cases, the heterogeneity observed for most of the P. aeruginosa isolates showed that outbreak situations were rare in the F. Bourguiba hospital during the study period. MLVA genotyping is a good tool for genotyping P. aeruginosa clinical isolates.

Salmonella non typhoidique : une cause rare d'infection urinaire

Le but de notre travail est d'analyser les aspects cliniques; bacteriologiques et therapeutiques des infections urinaires a Salmonella non typhi (SNT) dans notre region. Patients et methodes : Il s'agit d'une etude descriptive retrospective ayant concerne les cas d'infections urinaires a SNT diagnostiques a l'hopital Sahloul (Sousse; Tunisie) recenses sur une periode de six ans et demi (Janvier 2003-Juin 2009). Les souches ont ete identifiees grace a leurs caracteres morphologiques; biochimiques et antigeniques. Un antibiogramme a ete effectue. Resultats : 9 cas d'infection urinaire a SNT ont ete ainsi recenses; soit 0;079des infections urinaires colligees au laboratoire de microbiologie durant la meme periode. L'age moyen des patients etait de 45 ans. Un terrain debilite etait note chez 8 des 9 patients. Les facteurs favorisants notes etaient variables et parfois associes chez un meme patient: diabete (4 cas); traitement corticoide et immunosuppresseur (3 cas); insuffisance renale (3 cas); reflux vesico-uretral (1 cas); pathologie tumorale (4 cas); lupus erythemateux systemique (1 cas); hypertrophie prostatique (1 cas). Les serotypes notes etaient Salmonella enteritidis (8 cas); Salmonella typhimurium (1 cas). L'evolution sous antibiotherapie adaptee (duree moyenne de 16.4 jours) etait favorable dans 7 cas. Conclusion : L'infection urinaire a SNT survient en regle sur un terrain predispose notamment un diabete sucre; une uropathie ou un etat d'immunodepression. Le traitement antibiotique doit etre suffisamment prolonge pour eviter les complications et les recidives

[Susceptibility patterns of Pseudomonas aeruginosa strains isolated in the Monastir region, Tunisia]. / Profil de sensibilité aux antibiotiques des souches de Pseudomonas aeruginosa isolées dans la région de Monastir.

The aim of this study was to determine the susceptibility rates and patterns in P. aeruginosa strains isolated from 2002 to 2005 in a teaching Hospital of Tunisia. Susceptibility to antibiotics was assessed according to CA-SFM guidelines. During this period, 1368 strains of P. aeruginosa were identified, they were isolated mainly from pus (52.9%), respiratory samples (19.5 %), urine (10.6%), and blood cultures (5%). The percentages of resistant isolates were as follows: ticarcilline: 26.2%; ceftazidime: 21.8%; imipenem: 19.6%; gentamicin: 39.3%; amikacin: 19.2%, and ciprofloxacin: 21.6%. Nosocomial infections in P. aeruginosa are responsible for important morbidity and mortality rates, the survey of resistance to antibiotics is necessary for an efficient treatment.

Group A rotavirus strains circulating in the eastern center of Tunisia during a ten-year period (1995-2004).

An epidemiological survey investigating rotavirus infections in children was undertaken in the Eastern Center of Tunisia between January 1995 and December 2004. A total of 982 faecal specimens collected from children less than 5 years in age were screened by enzyme-linked immunosorbent assay (ELISA) or latex agglutination assay for the presence of group A rotavirus antigen. Rotavirus-positive samples were used for G and P typing by multiplex semi-nested reverse transcription-PCR. Rotaviruses were detected in 22% (n = 220) of stools. Of these, 164 were typed for VP7: G genotypes found were G1 (59%), G2 (2%), G3 (9%), G4 (10%), G8 (1%), and G9 (1%). Sixteen specimens (9%) showed mixed G profiles. A total of 119 specimens were typed for VP4. P genotypes detected were P[8] (32%), P[6] (15%), and P[4] (13%). Mixed P profiles were also detected (6%). Although the distribution of the detected genotypes appeared to change annually, G1P[8] rotavirus strains always predominated during the 10-year period of study. This is the first report of rotaviruses in Tunisia with unconventional VP7 serotypes such as G8 and G9, highlighting the need for continual surveillance of emerging strains in Northern Africa. Indeed, the new commercial vaccines only contain the VP7 genes that dictate G1 or G1 to G4 specificities. These vaccines may protect less well against unusual strains circulating in countries planning to implement a rotavirus vaccine strategy.