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1.
Arch Virol ; 165(1): 33-42, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31630275

RESUMO

Hepatocellular carcinoma (HCC) is a major public health issue in Africa. In Tunisia, hepatitis B virus (HBV) is known to be an important risk factor for HCC in the south of the country, but the role played by hepatitis C virus (HCV) still remains unclear. The aim of the current case-control study was to identify risk factors for HCC development in the northern part of the country. Clinical and biological data including viral hepatitis status (serological and molecular) and non-infectious risk factors from 73 patients with HCC and 70 control subjects without hepatic diseases were collected. The mean age of the patients was 63 ± 10 years, and the ratio of males to females was 1.1. HCC occurred in cirrhotic liver in 72.0% of the cases. HCV infection was the dominant risk factor (64.3% of cases); the presence of HBV was observed in 53.4% of the cases. Occult hepatitis B and C were implicated, respectively, in 30.1% and 9.6% of the cases. HCV genotype 1b was predominant. Patients originating from western Tunisia formed a homogeneous group, characterized by significantly higher rates of tattoos or scarifications (83%) and HCV infection (80%) than those from other parts of the country. Chronic HCV infection is currently the primary risk factor for HCC in Tunisia; HBV infection remains frequent in its overt or occult infection forms. Traditional esthetic practices apparently contribute to increasing the burden of terminal liver diseases in western Tunisia.


Assuntos
Carcinoma Hepatocelular/epidemiologia , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Cirrose Hepática/virologia , Neoplasias Hepáticas/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/virologia , Estudos de Casos e Controles , Feminino , Genótipo , Hepatite B/complicações , Hepatite C/complicações , Humanos , Cirrose Hepática/complicações , Neoplasias Hepáticas/virologia , Masculino , Pessoa de Meia-Idade , Medição de Risco , Tunísia/epidemiologia
2.
Sante Publique ; Vol. 31(3): 433-441, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31640331

RESUMO

OBJECTIVES: Non-communicable diseases (NCDs) represent a major public health problem worldwide. Giving their impact on the morbidity and mortality burden, understanding their chronological trends over time is a priority for epidemiological surveillance. We aimed to determine the epidemiological specificities of NCDs and to study their chronological trends over the period 2010-2015. METHODS: We retrospectively collected data of hospitalized patients from the regional registry of morbidity and mortality in the Southern University Hospital of Tunisia during the period 2010-2015. RESULTS: We included 18,081 patients with NCDs aged ≥ 25 years. The distribution of NCDs was characterized by the predominance of cardiovascular disease (CVD) (10,346 cases, 57.2%). Chronological trends analysis of NCDs showed that NCDs remained globally stable between 2010 and 2015. The same result applied to the group of cancers, chronic respiratory diseases and diabetes mellitus. However, CVD increased significantly between 2010 and 2015 (ρ = 0.84; p = 0.036). The proportion of CVD increased significantly among men (ρ = 0.87; p = 0.019) and elderly (ρ = 0.88; p = 0.019). The hospital mortality rate of NCDs increased significantly (ρ = 0.85; p = 0.031), notably for CVDs (ρ = 0.94; p = 0.005). CONCLUSION: Chronological trends analysis revealed a significant rise in the morbidity and mortality burden of CVDs during the period 2010-2015. It is imperative, therefore, to strengthen health care for these patients and to introduce the concept of integrated NCDs prevention as an essential component of the health system.


Assuntos
Doenças não Transmissíveis/epidemiologia , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Humanos , Masculino , Morbidade/tendências , Mortalidade/tendências , Doenças não Transmissíveis/mortalidade , Sistema de Registros , Estudos Retrospectivos , Tunísia/epidemiologia
3.
Sante Publique ; Vol. 31(3): 443-450, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31640332

RESUMO

BACKGROUND: The identification of psychosocial constraints in the sector of mass retail is necessary to set up and guide preventive strategies. AIM OF THE STUDY: To evaluate the prevalence of psychosocial constraints among employees working in a large supermarket chains. METHODS: A descriptive cross-sectional survey conducted in employees of grocery stores. The study was based on a questionnaire exploring their socio-professional characteristics and on the Karasek questionnaire. RESULTS: 245 workers participated in the study. The average age was 32.4±6.4 years. Sex-ratio was 0.84. Occupational seniority was 6.3 years (min=1 year; max=18 years). The category of employees was the most represented (56%); the cashiers and the executives represented respectively 24.5 and 19.5%. A job strain situation was observed in 28.2 % of cases. It varied significantly with occupational seniority (p=0.03). The employees and the cashiers represented the most exposed posts. A high job demands was observed in 48,2% of the cases. The employees working in a supermarket are more exposed than those working in a minimarket (p<0,001). A low job control was found in 61.2 % of cases. It was more important among the employees having a permanent employment contract (p=0.01). A low job suport was found in 65,3% of cases. A situation of isostrain was observed in 20%. CONCLUSION: According our results, workers in grocery stores are exposed to psychosocial risk factor. The implementation of strategies to reduce stress factors at work is required.


Assuntos
Comércio , Estresse Ocupacional/epidemiologia , Ocupações/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Fatores de Risco , Tunísia/epidemiologia
4.
PLoS Negl Trop Dis ; 13(9): e0007707, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31532767

RESUMO

INTRODUCTION: In Tunisia, almost 77% of clinically and bacteriologically diagnosed cases of extrapulmonary tuberculosis (EPTB) are zoonotic TB, caused by M. bovis. Although several studies have analyzed bovine TB in cattle in Tunisia, no study has evaluated the risk of transmission to humans in such an endemic country. We aimed to study the genetic diversity of M. bovis human isolates, to ascertain the causes of human EPTB infection by M. bovis and to investigate the distribution and population structure of this species in Tunisia. MATERIALS AND METHODS: A total of 110 M. bovis isolates taken from patients with confirmed EPTB were characterized by spoligotyping and MIRU-VNTR typing methods. RESULTS: Among the 15 spoligotypes detected in our study, 6 (SB0120, SB0121, SB2025, SB1200, SB1003 and SB0134) were the most prevalent (83.5%) of which SB0120, SB0121 and SB2025 were the most prevailing. MIRU-VNTR typing method showed a high genotypic and genetic diversity. The genetic differentiation based on MIRU-VNTR was significant between populations from South East (Tataouine, Medenine) and Central West (Gafsa, Sidi Bouzid, Kasserine) regions. Of note, 13/15 (86.7%) spoligotypes detected in our study were previously identified in cattle in Tunisia with different frequencies suggesting a peculiar ability of some genotypes to infect humans. Using combined spoligotyping and MIRU-VNTR method, a high clustering rate of 43.9% was obtained. Our results underlined that human EPTB due to M. bovis was more commonly found in female gender and in young patients. Most of our patients, 66.4% (73/110) were raw milk or derivatives consumers, whereas 30.9% (34/110) patients would have contracted EPTB through contact with livestock. The findings suggest that the transmission of Zoonotic TB caused by M. bovis to humans mainly occurred by oral route through raw milk or derivatives. CONCLUSION: Our study showed the urgent need of a better veterinary control with the implementation of effective and comprehensive strategies in order to reach a good protection of animals as well as human health.


Assuntos
Mycobacterium bovis/genética , Tuberculose/microbiologia , Adolescente , Adulto , Idoso , Animais , Criança , Pré-Escolar , Feminino , Variação Genética , Genótipo , Técnicas de Genotipagem , Humanos , Lactente , Líbia/etnologia , Gado , Masculino , Pessoa de Meia-Idade , Leite , Mycobacterium bovis/isolamento & purificação , Estudos Prospectivos , Tuberculose/epidemiologia , Tunísia/epidemiologia , Zoonoses
5.
BMC Infect Dis ; 19(1): 819, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533664

RESUMO

BACKGROUND: Reports on the worldwide ascending trend of pulmonary nontuberculous mycobacteria (NTM) isolation rates and their effective role in respiratory tract infections are compelling. However, as yet, there are no such data relating to Tunisia. METHODS: Here we carried out a retrospective review of mycobacterial cultures originating from Northern Tunisia, which have been processed in the laboratory of mycobacteria of the Institut Pasteur de Tunis, during the time period 2002-2016. All pulmonary NTM (PNTM) isolates available for culture were characterized phenotypically and their taxonomic status was further established based on polymorphisms in rpoB, 16S rRNA, hsp65, and sodA DNA gene sequences. RESULTS: Of the 10,466 specimens collected from HIV-negative Tunisian patients with presumptive clinical pulmonary TB, 60 (0.6%) yielded PNTM isolates. An overall annual PNTM isolation prevalence of 0.2/100,000 was estimated. As far as could be ascertained, this isolation rate accounts amongst the lowest reported hitherto throughout the world. Among the 30 NTM isolates that were available for culture, 27 (90.0%) have been identified to the species level. The most commonly encountered species was Mycobacterium kansasii (23.3%) subtype 1. Strikingly, all M. kansasii cases were male patients originating from Bizerte, an industrialized region particularly known for iron industry. The remaining NTM species were M. fortuitum (16.6%), M. novocastrense (16.6%), M. chelonae (10.0%), M. gordonae (6.6%), M. gadium (6.6%), M. peregrinum (3.3%), M. porcinum (3.3%), and M. flavescens (3.3%). There were no bacteria of the M. avium complex, the most frequently isolated NTM globally, and the main driver of the rise of NTM-lung diseases. CONCLUSIONS: This study uncovered an exceptional low prevalence of PNTM isolation among HIV-negative TB suspects in Northern Tunisia, suggesting a very low burden of NTM pulmonary disease. However, the frequent isolation of M. kansasii subtype 1, the most pathogenic subtype, particularly from the industrialized region of Bizerte, strongly suggests its effective involvement in a typical pulmonary disease.


Assuntos
Infecções por Micobactéria não Tuberculosa/diagnóstico , Micobactérias não Tuberculosas/isolamento & purificação , Tuberculose Pulmonar/diagnóstico , Adulto , Líquido da Lavagem Broncoalveolar/microbiologia , Feminino , Humanos , Masculino , Infecções por Micobactéria não Tuberculosa/epidemiologia , Infecções por Micobactéria não Tuberculosa/microbiologia , Micobactérias não Tuberculosas/classificação , Micobactérias não Tuberculosas/genética , Filogenia , Prevalência , RNA Ribossômico 16S/química , RNA Ribossômico 16S/genética , RNA Ribossômico 16S/metabolismo , Estudos Retrospectivos , Escarro/microbiologia , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/microbiologia , Tunísia/epidemiologia
6.
Pan Afr Med J ; 33: 108, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31489086

RESUMO

Home accidents are a serious public health problem in Pediatrics. They are responsible for heavy morbidity and mortality in the paediatric population. We conducted a retrospective study of 231 cases of domestic accidents in childhood in the Division of General Pediatrics at the Hedi Chaker Hospital, Sfax over a period of 5 years (2008-2012). During the study period, we collected data from 231 domestic accidents. The study involved 124 boys (53.7 %) and 107 girls (46.3%). The average age of patients was 2 years, ranging from 1 day to 14 years; children under 4 years were the most exposed to home accidents (88.7%). Accidental poisonings were the most common accidents (105 cases). Caustics were the most common toxic agents (33 cases), followed by drugs (28 cases) and hydrocarbons (16 cases). Foreign body accidents were the second most common mechanism of injury (64 cases). They included 43 cases of inhalation of foreign bodies and 21 cases of foreign body ingestion. We recorded 28 cases of trauma, 25 cases were caused by a fall from a certain height. We noted 26 cases of scorpion envenomation, 5 cases of drowning, 2 cases of burn and a single case of electric shock. Accidental poisonings and foreign body accidents were the main home accidents noted during our study and the age group 1 -4 years was the most exposed to home accidents.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Acidentes Domésticos/estatística & dados numéricos , Corpos Estranhos/epidemiologia , Envenenamento/epidemiologia , Adolescente , Fatores Etários , Queimaduras/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Envenenamento/etiologia , Estudos Retrospectivos , Picadas de Escorpião/epidemiologia , Tunísia/epidemiologia
7.
Bull Soc Pathol Exot ; 112(2): 71-78, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31478620

RESUMO

Spondylodiscitis is a common but potentially serious form of extra-pulmonary tuberculosis. Very few descriptions are known from Tunisia. We have conducted a retrospective study including 60 cases of spinal tuberculosis, performed over a period of 20 years (1996-2016). The diagnosis was retained on bacteriological, radiological and anatomopathologic evidence. Sixty cases including 31 women and 29 men of spinal tuberculosis were involved. The mean age was 54.4 ±â€…21.3 years. The delay from onset to diagnosis was 6 months (1-14). Lumbar region was the most common infection site (68%). The magnetic resonance imaging has confirmed spinal infection in all cases. The percutaneous image guided spinal biopsy was conclusive in 24/42 cases (57.1%). All patients were put under anti-tuberculosis treatment with total treatment duration of 14 months. Fourteen patients underwent surgical act. The outcome was favorable in 42 cases (7%). Advanced age ≥ 65 years (P = 0.026), radiological evidence of spinal cord compression (P = 0.033) or abscess (P = 0.024), hyperleucocytosis higher than 11,500 elements/mm3 (0.031), or fractures on bone imaging (P = 0.018) and vertebral deformity (P < 0.001) were strongly linked to a bad outcome. Early diagnosis and treatment onset may ensure better outcomes and reduce neurological complications and vertebral deformity.


Assuntos
Discite/diagnóstico , Discite/epidemiologia , Tuberculose da Coluna Vertebral/diagnóstico , Tuberculose da Coluna Vertebral/epidemiologia , Adulto , Idoso , Antituberculosos/uso terapêutico , Estudos de Coortes , Discite/tratamento farmacológico , Discite/microbiologia , Feminino , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/microbiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Tuberculose da Coluna Vertebral/tratamento farmacológico , Tunísia/epidemiologia
8.
Ticks Tick Borne Dis ; 10(6): 101260, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31327747

RESUMO

In camels and their infesting ectoparasites, specific detection of pathogenic Anaplasma platys and genetically related strains (A. platys-like strains) remains problematic. This requires sequencing of the hemi-nested PCR products specific to A. platys and related strains. In this study, a PCR/RFLP method, earlier developed for specific detection of A. platys-like strains in animal species other than camels, was adapted in order to subtype A. platys-like strains isolated from camels and their ticks and to differentiate them from pathogenic A. platys without going through a sequencing step. This approach was used for investigating the infections with A. platys and related strains in 412 Camelus dromedarius camels and 334 feeding ticks from five Tunisian governorates. Microscopic examination using Giemsa-stained blood smears was performed in order to specify which types of cells were infected. Ticks were identified as Hyalomma dromedarii (n = 164, 49%), H. impeltatum (n = 161, 48.3%) and H. excavatum (n = 9, 2.7%). A. platys was not detected in any of the tested camels or ticks. The overall prevalence of A. platys-like strains was 5.6% (23/412) in camels and microscopic examination of infected cells showed a tropism for neutrophil granulocytes. One tick identified as H. dromedarii out of 327 analyzed ticks was found to be infected with A. platys-like strains (0.3%). Alignment, identity comparison and phylogenetic analysis of the 16S rRNA partial sequences obtained in this study suggest that Tunisian dromedaries and feeding ticks are infected with different Anaplasma strains genetically related to A. platys. Sequence analysis and phylogenetic study based on the groEL gene confirm the RFLP results and show that camel strains formed a separate sub-cluster relatively close to A. platys-like strains infecting Tunisian cattle. This adapted RFLP assay allows fast and specific detection of pathogenic A. platys and A. platys-like strains in camels and infesting ticks and has the intrinsic potential of revealing co-infections with these two types of bacteria in the same sample, reducing the time and costs associated with cloning and sequencing during molecular diagnosis.


Assuntos
Anaplasma/isolamento & purificação , Anaplasmose/epidemiologia , Camelus , Ixodidae/microbiologia , Infestações por Carrapato/veterinária , Anaplasma/genética , Anaplasmose/microbiologia , Animais , Proteínas de Bactérias/análise , Sequência de Bases , Chaperonina 60/análise , DNA Bacteriano/análise , Feminino , Ixodidae/fisiologia , Masculino , Filogenia , Prevalência , RNA Bacteriano/análise , RNA Ribossômico 16S/análise , Infestações por Carrapato/epidemiologia , Tunísia/epidemiologia
9.
J Med Microbiol ; 68(9): 1320-1323, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31329091

RESUMO

The recent increase in pertussis cases observed in some countries may have several causes, including the evolution of Bordetella pertussis populations towards escape of vaccine-induced immunity. Most genomic studies of B. pertussis isolates performed so far are from countries that use acellular vaccines. The objective was to analyse genomic sequences of isolates collected during the 2014 whooping cough epidemic in Tunisia, a country where whole-cell vaccines are used. Ten Tunisian isolates and four vaccine strains were sequenced and compared to 169 isolates from countries where acellular vaccines are used. Phylogenetic analysis showed that Tunisian isolates are diverse, demonstrating a multi-strain 2014 epidemic peak, and are intermixed with those circulating in other world regions, showing inter-country transmission. Consistently, Tunisian isolates have antigen variant composition observed in other world regions. No pertactin-deficient strain was observed. The Tunisian B. pertussis population appears to be largely connected with populations from other countries.


Assuntos
Bordetella pertussis/genética , Variação Genética , Genoma Bacteriano/genética , Filogenia , Coqueluche/microbiologia , Antígenos de Bactérias/genética , Proteínas da Membrana Bacteriana Externa/genética , Bordetella pertussis/classificação , Bordetella pertussis/imunologia , Bordetella pertussis/isolamento & purificação , DNA Bacteriano/genética , Humanos , Lactente , Recém-Nascido , Epidemiologia Molecular , Vacina contra Coqueluche/administração & dosagem , Vacina contra Coqueluche/genética , Análise de Sequência de DNA , Tunísia/epidemiologia , Virulência/genética , Fatores de Virulência de Bordetella/genética , Coqueluche/epidemiologia , Coqueluche/transmissão
10.
Am J Forensic Med Pathol ; 40(4): 366-370, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31318709

RESUMO

BACKGROUND: Death in workplaces remains a public health issue. However, data regarding workplace homicides are scarce in most of regions, especially in the Arab world. The aim of our study was to analyze the epidemiological features of workplace homicides in northern Tunisia. MATERIALS AND METHODS: This is a descriptive study with retrospective data collection over a 15-year period (January 2003 to December 2017). RESULTS: We recorded 50 workplace homicide cases. Sex ratio was 49:1 (male/female). The mean age was 41.6 ± 15.13 years. Occupations the most at risk were security guards (odds ratio, 8.25; 95% confidence interval, 4.28-15.91; P < 0.0001) and taxi drivers (odds ratio, 5.61; 95% confidence interval, 2.39-13.18; P < 0.00001). The motive of the aggression was either interpersonal conflict or robbery (47.9% and 43.8%, respectively). Victims working as security guards or taxi drivers were most frequently assaulted by an unknown perpetrator, the motive being robbery. Death was most frequently secondary to blunt trauma (n = 20) or stab wounds (n = 15). CONCLUSIONS: Workplace homicides represent a substantial phenomenon in Tunisia. The application of prevention measures is required based on improving environmental measures targeting, in priority, security guards and taxi drivers.


Assuntos
Homicídio/estatística & dados numéricos , Violência no Trabalho/estatística & dados numéricos , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Vítimas de Crime/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Ocupações/estatística & dados numéricos , Estudos Retrospectivos , Distribuição por Sexo , Tunísia/epidemiologia , Ferimentos não Penetrantes/mortalidade , Ferimentos Perfurantes/mortalidade , Adulto Jovem
11.
Pan Afr Med J ; 32: 204, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31312316

RESUMO

Background: Suicidal behaviors are increasing in Tunisia at younger and younger ages. This study aims to describe the sociodemographic and clinical profile of suicide attempts in children and adolescents. Methods: We conducted a cross-sectional and descriptive study, including 50 suicidal individuals, recruited in the Child Psychiatry Department at the Razi Hospital in Manouba and in two Departments in Tunisia (Intensive Care and Reanimation Department and Department of Pediatrics) between July 2012 and June 2013. We identified the socio-demographic and clinical factors, the histories of abuse, subjects' education, the characteristics of the attempted suicides (TS), suicidal ideation assessed by the Suicidal Intent Scale and psychopathological disorders diagnosed using the Mini-International Neuropsychiatric Interview. Results: The sex-ratio was 0.56, the average age was 12.4 years ranging from 7 to 16 years. School failure or dropout were found in 86% of suicidal individuals. In 38% of cases suicidal behavior was recurrent; the subjects had a history of self-mutilation to the same extent. A context of abuse was reported in 46% of cases. Drug ingestion was the most common means of suicide, psychotropic drugs were the most common substances used. There was a significant gender difference in the use of the means of suicide: the boys mainly used physical means (P=0.04) while the girls poisoning (P=0.001). Suicidal intent was high in 44% of cases. A major depressive episode and adjustment disorder were the most common disorders found (58% and 24% of cases respectively). Conclusion: Depressive disorders and abuse are risk factors of TS in children and adolescents, these factors should be considered when implementing suicide prevention strategies for this population.


Assuntos
Maus-Tratos Infantis/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Ideação Suicida , Tentativa de Suicídio/estatística & dados numéricos , Transtornos de Adaptação/epidemiologia , Adolescente , Criança , Estudos Transversais , Transtorno Depressivo Maior/epidemiologia , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Psicotrópicos/administração & dosagem , Recidiva , Fatores de Risco , Comportamento Autodestrutivo/epidemiologia , Fatores Sexuais , Tentativa de Suicídio/psicologia , Tunísia/epidemiologia
12.
BMC Public Health ; 19(1): 694, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31170955

RESUMO

BACKGROUND: This study was initiated to evaluate, for the first time, the performance and quality of the influenza-like illness (ILI) surveillance system in Tunisia. METHODS: The evaluation covered the period of 2012-2015 and used different data sources to measure indicators related to data quality and completeness, representativeness, timeliness, simplicity, acceptability, flexibility, stability and utility. RESULTS: During the evaluation period, 485.221 ILI cases were reported among 6.386.621 outpatients at 268 ILI sentinel sites. To conserve resources, cases were only enrolled and tested for influenza during times when the number of patients meeting the ILI case definition exceeded 7% (10% after 2014) of the total number of outpatients for the week. When this benchmark was met, five to 10 patients were enrolled and sampled by nasopharyngeal swabs the following week. In total, The National Influenza Center (NIC) received 2476 samples, of which 683 (27.6%) were positive for influenza. The greatest strength of the system was its representativeness and flexibility. The timeliness of the data and the acceptability of the surveillance system performed moderately well; however, the utility of the data and the stability and simplicity of the surveillance system need improvement. Overall, the performance of the Tunisian influenza surveillance system was evaluated as performing moderately well for situational awareness in the country and for collecting representative influenza virologic samples. CONCLUSIONS: The influenza surveillance system in Tunisia provided pertinent evidence for public health interventions related to influenza situational awareness. To better monitor influenza, we propose that ILI surveillance should be limited to sites that are currently performing well and the quality of data collected should be closely monitored and improved.


Assuntos
Influenza Humana/epidemiologia , Saúde Pública/estatística & dados numéricos , Vigilância de Evento Sentinela , Adulto , Idoso , Conscientização , Benchmarking , Confiabilidade dos Dados , Testes Diagnósticos de Rotina/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/estatística & dados numéricos , Tunísia/epidemiologia
13.
J Med Microbiol ; 68(8): 1240-1243, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31237533

RESUMO

The aim of the present study was to report the molecular characterization of human group A rotaviruses (RVAs) circulating in Tunisia. Stool specimens were collected from children under 5 years of age who had been hospitalized or were consulting for gastroenteritis in Tunisian hospitals between 2015 and 2017. All samples were screened by reverse-transcription polymerase chain reaction (RT-PCR) for the detection of the VP6 gene specific for RVA. RVA-positive samples were further analysed for G/P genotyping by semi-nested multiplex RT-PCR. Among 454 tested samples, 72 (15.8 %) were positive for RVA. G1P[8] was the most prevalent detected strain (41.7%), followed by G9P[8] (32.8%), G2P[4] (7.5%), G12P[8] (7.5%), G1P[6] (3.0%), G2P[8] (1.5%) and G3P[8] (1.5%), with mixed infections in 4.5 % of cases. In the absence of a national anti-rotavirus vaccination strategy, RVAs remain the primary aetiological agent for gastroenteritis in Tunisian children.


Assuntos
Gastroenterite/virologia , Infecções por Rotavirus/virologia , Rotavirus/genética , Proteínas do Capsídeo/genética , Pré-Escolar , Fezes/virologia , Gastroenterite/epidemiologia , Variação Genética , Genótipo , Humanos , Lactente , Recém-Nascido , Epidemiologia Molecular , Prevalência , RNA Viral/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Rotavirus/isolamento & purificação , Infecções por Rotavirus/epidemiologia , Estações do Ano , Análise de Sequência de DNA , Tunísia/epidemiologia
14.
Parasite ; 26: 35, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31198174

RESUMO

Free-ranging spur-thighed tortoises Testudo graeca, captured in different habitat types of Northern Tunisia from March to April 2017, were examined for tick infestation: 134/147 (91%) were infested. The overall infestation intensity and abundance was 8.5 and 7.8, respectively. From these tortoises, 1174 ticks were collected, of which 10% (n = 120) taken from 18 randomly-selected tortoises were identified at the species level; the remaining ticks were examined for the presence of Crimean-Congo haemorrhagic fever virus (CCHFv) by real time RT-PCR. Only adult Hyalomma aegyptium were found, suggesting a high degree of host specificity to tortoises. No CCHFv was detected in ticks. Considering the absence of CCHFv in Hyalomma aegyptium infesting its main host, the spur-thighed tortoise, this tick species is unlikely to play a major role in the epidemiology of CCHF. Therefore, more studies are needed to investigate the circulation of this arbovirus between livestock and other tick species from North Africa.


Assuntos
Vírus da Febre Hemorrágica da Crimeia-Congo/isolamento & purificação , Febre Hemorrágica da Crimeia/veterinária , Infestações por Carrapato/veterinária , Carrapatos/virologia , Tartarugas/parasitologia , Animais , Feminino , Vírus da Febre Hemorrágica da Crimeia-Congo/genética , Febre Hemorrágica da Crimeia/epidemiologia , Especificidade de Hospedeiro , Masculino , Reação em Cadeia da Polimerase em Tempo Real , Infestações por Carrapato/epidemiologia , Tunísia/epidemiologia
15.
Arch Virol ; 164(9): 2243-2253, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31179516

RESUMO

This study aimed to assess the seroprevalence, viraemia and genotype distribution of hepatitis C virus (HCV) in a region in Central-West Tunisia. A door-to-door cross-sectional study was conducted on a randomly selected sample. A total of 3178 individuals aged 5 to 74 years and members of 935 families were investigated. Seroprevalence of HCV was assessed using ELISA tests. The viral load was determined by real-time RT-PCR, and HCV genotyping was conducted by amplification and sequencing in the NS5b genomic region. The global prevalence of HCV antibodies was 3.32% (95% confidence interval [CI]: 2.72-4.00). It was significantly higher in women: 4.47% vs. 2.16% in men, p = 0.001. Seroprevalence increased with age, and the highest rates were found in the 50- to 59-year-old age group (12.90%, 95% CI: 9.45-16.86), suggesting a cohort effect with very low contribution of intrafamilial transmission. Genotyping showed a predominance of subtype 1b (84.6%), with cocirculation of subtypes 2c (9.6%), 1a (1.9%), 1d (1.9%) and 2k (1.9%), similar to the previously reported genotype distribution in Tunisia and with no genetic clusters specific to the study region. These results indicate a higher endemicity of HCV infection when compared to the previously reported nationwide surveillance data. This study provides valuable data that can contribute to current strategies to eliminate hepatitis C.


Assuntos
Hepacivirus/isolamento & purificação , Hepatite C/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , Feminino , Genótipo , Hepacivirus/classificação , Hepacivirus/genética , Hepacivirus/imunologia , Hepatite C/sangue , Hepatite C/virologia , Anticorpos Anti-Hepatite C/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Filogenia , Prevalência , Estudos Soroepidemiológicos , Tunísia/epidemiologia , Proteínas não Estruturais Virais/genética , Proteínas não Estruturais Virais/imunologia , Adulto Jovem
16.
Arch Virol ; 164(9): 2327-2332, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31177352

RESUMO

Two distinct genotypes responsible for rabbit hemorrhagic disease (RHD) are reported, GI.1 (RHDV) and GI.2 (RHDV2). Vaccines based on these two genotypes are only partially cross-protective. Hence, knowing which genotype is circulating is important for appropriate control measures. We have investigated 25 field samples isolated between 2015 and 2018 from rabbits with clinical signs of RHD. Only GI.2 (RHDV2) is currently circulating in Tunisia. All Tunisian samples were grouped together with typical genotypic and phenotypic mutations. Therefore, we recommend initiating an extensive preventive vaccination program based on GI.2 vaccines in addition to a regular monitoring of the circulating lagoviruses.


Assuntos
Infecções por Caliciviridae/veterinária , Vírus da Doença Hemorrágica de Coelhos/genética , Vírus da Doença Hemorrágica de Coelhos/isolamento & purificação , Filogenia , Coelhos/virologia , Sequência de Aminoácidos , Animais , Infecções por Caliciviridae/epidemiologia , Infecções por Caliciviridae/virologia , Genótipo , Vírus da Doença Hemorrágica de Coelhos/química , Vírus da Doença Hemorrágica de Coelhos/classificação , Dados de Sequência Molecular , Alinhamento de Sequência , Tunísia/epidemiologia , Proteínas Virais/química , Proteínas Virais/genética , Proteínas Virais/metabolismo
17.
Saudi J Kidney Dis Transpl ; 30(3): 678-685, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31249233

RESUMO

The increased incidence of the acute kidney injury (AKI) in the elderly is becoming a disturbing reality in our days, mainly with the aging of the general population, and the predisposition of old persons to chronic diseases, drug toxicity, and infections. The aim of this study was to investigate the epidemiological, clinical, and biological features and to assess variant etiologies and outcomes of AKI in the elderly. Data were collected from the medical records of patients older than 65 years age having AKI admitted in the Internal Medicine Department of the Military Hospital of Tunis from January 2006 to June 2014. One hundred and seventeen cases were included in the study. The median age was 74.2 years. Male:female ratio was 1.6. Hypertension and diabetes were the most frequently found comorbidities seen in 69.2% and 48.7% of patients, respectively. The percentage of patients having acute-on-chronic renal failure was 13.7%. The AKI was manifested by nausea or vomiting in 33.3% of cases. One patient had hematemesis. The other symptoms were dyspnea in 14.5% of cases, uremic encephalopathy in 6.8% of cases, and oligoanuria in 16.2% of cases. The AKI was discovered fortuitously in 31.6% of cases and was diagnosed early within the 48 h after admission in 94% of cases and after this delay, in 6% of cases. It was ranked Acute Kidney Injury Network 1, 2, or 3, respectively, in 29.9%, 24.8%, and 45.3% of cases. Organic etiologies were observed more frequently (53.8%) followed by functional etiologies (37.6%) and then by obstructive ones (8.5%). Hemodialysis was performed for 9.4% of the patients. Of all the patients, 70.1% had favorable outcome, 49.6% of patients recovered totally. There was aggravation of the AKI in 29.9% of cases. Death occurred in eight cases (6.8%). The epidemiological, clinical, biological, and etiological profile of AKI in the elderly emphasizes the effect of aging of the human being on determining the pathology.


Assuntos
Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/terapia , Fatores Etários , Idoso , Comorbidade , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Diagnóstico Precoce , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Masculino , Registros Médicos , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Tunísia/epidemiologia
18.
Biomed Res Int ; 2019: 1793973, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31205935

RESUMO

Introduction: Weather conditions were implicated in the onset of spontaneous pneumothorax (SP). Aim: Investigate the influence of weather conditions on the onset of SP. Methods: A total of 200 patients with SP in Sousse (Tunisia) were enrolled in the study between January 2010 and December 2014. An analysis of two time series (meteorological data and pneumothorax cases) was performed. Data on weather conditions were collected daily throughout the 5-year period. Results: A comparison of the mean temperature between days with and without SP showed significantly higher temperatures during the days with SP. A decrease of 1% in the relative humidity one day lag (D-1) was associated with an increase in the risk of SP by 1.6% (p=0,02). The occurrence of clusters was associated significantly with higher temperature averages on the same days. This same observation was made regarding the mean duration of sunshine two days before the cluster onset (p = 0.05). The occurrence of storms two days before clusters was also significantly associated with a risk multiplied by 1.96. Conclusion: There was a correlation between clusters of spontaneous pneumothorax and weather conditions in the region of Sousse-Tunisia.


Assuntos
Pneumotórax/epidemiologia , Tempo (Meteorologia) , Feminino , Humanos , Masculino , Tunísia/epidemiologia
19.
Rev Epidemiol Sante Publique ; 67(4): 261-266, 2019 Jul.
Artigo em Francês | MEDLINE | ID: mdl-31060884

RESUMO

BACKGROUND: Hepatitis B is the main cause of liver disease in the world. Chronic hepatitis B may lead to cirrhosis, liver insufficiency or liver cancer. Tunisia is considered as a country with intermediate endemicity, where hepatitis B presents a real public health problem. The aims of this study were to evaluate the prevalence of viral biomarkers of hepatitis B in healthcare personnel; to look for potential risk factors associated with HbS antigen carriage and to evaluate the prevalence of vaccination in this particular population. METHODS: Sero-epidemiological, prospective and descriptive study, among 2411 healthcare personnel in the Military Hospital of Tunis, during a 5-month period from September 2013 to January 2014. RESULTS: Blood samples were collected from 1497 volunteers among the hospital staff. Two hundred and seventy-one individuals had a positive HbC antibody titer (prevalence 18.1%), including 229 who were positive for HbC and HbS antibodies (prevalence 15.3%), 12 positive for only HbC antibody (prevalence 0.8%), and 30 positive for HBsAg (prevalence 2%). Among HbS Ag carriers, 56.6% reported needle stick and sharp object injuries during their professional careers. Among HbS Ag carriers, there were three patients with a history of acute viral hepatitis with jaundice, and 27 patients (90%) who were asymptomatic and were diagnosed during our study. Among healthcare workers in the hospital, 56.1% were immunized through vaccination (positive HbS antibodies without HbC antibodies), of whom 66% had durable protective immunity (HbS antibodies>100mU/mL). Lastly, 25.8% of the hospital workers remained without any protection against hepatitis B (serology entirely negative) and were then offered a complete vaccination. CONCLUSION: Hepatitis B vaccine is the mainstay of hepatitis B prevention. Safe injection practices, blood safety and promoting wider access to monitoring and screening, care and treatment services for hepatitis B are the best guarantees to prevent and control this disease.


Assuntos
Biomarcadores/sangue , Pessoal de Saúde/estatística & dados numéricos , Vacinas contra Hepatite B/uso terapêutico , Hepatite B/sangue , Hepatite B/epidemiologia , Hepatite B/prevenção & controle , Vacinação/estatística & dados numéricos , Adulto , Anticorpos Antivirais/sangue , Feminino , Hepatite B/imunologia , Antígenos de Superfície da Hepatite B/sangue , Hospitais Militares/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Soroepidemiológicos , Tunísia/epidemiologia , Adulto Jovem
20.
Am J Trop Med Hyg ; 101(1): 101-107, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31094311

RESUMO

Cutaneous leishmaniasis (CL) remains one of the world's most prevalent neglected diseases, particularly in developing countries. Identification of the involved Leishmania species is an important step in the diagnosis and case management process. In this study, we tested simple, rapid, and highly sensitive loop-mediated isothermal amplification (LAMP) assays for Leishmania DNA species-specific detection from cutaneous lesions. Two LAMP assays, targeting cysteine protease B (cpb) gene, were developed to detect and identify Leishmania major and Leishmania tropica species. Loop-mediated isothermal amplification specificity was examined using DNA samples from other Leishmania species and Trypanosoma species. No cross-reactions were detected. The developed LAMP assays exhibited sensitivity with a detection limit of 20 fg and 200 fg for L. major and L. tropica, respectively. Both tests were applied on clinical samples of CL suspected patients living in endemic Tunisian regions and compared with kinetoplast DNA quantitative PCR (qPCR), microscopic, and conventional cpb-based polymerase chain reaction (PCR) assays. Our LAMP tests were able to discriminate between L. major and L. tropica species and showed a sensitivity of 84% and a specificity of 100%. However, when compared with the performance of the diagnostic tests with latent class analysis (LCA), our LAMP assays show a sensitivity of 100%. These assays can be used as a first-line molecular test for early diagnosis and prompt management of CL cases in public health programs.


Assuntos
Leishmania major/genética , Leishmania tropica/genética , Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/epidemiologia , Humanos , Leishmaniose Cutânea/parasitologia , Doenças Negligenciadas/diagnóstico , Doenças Negligenciadas/epidemiologia , Doenças Negligenciadas/parasitologia , Técnicas de Amplificação de Ácido Nucleico , Especificidade da Espécie , Tunísia/epidemiologia
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