[Role of Toscana virus in meningo-encephalitis in Tunisia]. / Rôle du virus Toscana dans les infections neuroméningées en Tunisie.

OBJECTIVES: To detect the presence of Toscana virus (TOSV) circulation in Tunisia and to study its role in viral meningo-encephalitis. PATIENTS AND METHODS: A total of 315 (167 sera and 178 cerobrospinal fluid [CSF]) samples was investigated. These samples are colleted from Tunisian patients with neurological diseases during the period between January 2003 and December 2009. All samples were tested negative for enterovirus, Herpes Simplex virus and West Nile virus. Detection for IgM and IgG specific to TOSV was done by ELISA tests. RESULTS: Specific IgM for TOSV were detected in 10 % of patients with neurological diseases (31 cases). These recent infections were distributed throughout the study period and predominated during summer and automn. Patients were originated, in the majority from the coastal region. IgG were isolated in 22 cases (7 %) corresponding to previous infection. CONCLUSION: This is the first report of TOSV circulating in Tunisia and its frequent implication in neurological diseases. These results incited to include TOSV as one of the viral etiologies to target in the diagnosis of viral meningitis and encephalitis in the country.

[Sero-epidemiological study of West Nile virus circulation in human in Tunisia]. / Étude séroépidémiologique de la circulation du virus West Nile chez l'Homme en Tunisie.

West Nile virus (WNV) is an arbovirus classified into the family of Flaviviridae, genus Flavivirus. It is responsible for neurological diseases that occurred frequently as outbreaks and considered as an emerging infection in different regions of the world. In Tunisia, two outbreaks of meningoencephalitis due to this virus occurred, in 1997 and 2003. The virus circulation is studied only in Sahel, region affected by the two epidemics. The aim of this study is to determine if WNV is present in other regions of the country where, up to now, no data are available. A total of 1,854 sera collected from healthy patients were investigated by ELISA to detect specific IgG, during January to December 2007. Patients included are from three governorates: Kairouan, Bizerte, and Sfax. The governorate of Sfax (center of Tunisia) was affected by the two outbreaks, whereas only two cases were observed previously at Kairouan and no cases at Bizerte. Specific IgG were detected in 12.5% of studied population. This seroprevalence varied largely between the three governorates studied. Globally, three regions with different endemicity were described: high endemicity at Kairouan (27.7%), moderate at Sfax (7.5%), and low at Bizerte (0.7%). At Kairouan, the seroprevalence is significantly higher in individuals aged over 40. Our results suggest that WNV circulates in Tunisia; it has a high risk not only in regions affected by previous outbreaks but throughout the country. An active surveillance should be instituted in the country. It must target individuals, and animals, which can be vectors or reservoirs for the virus.

Does bacterial colonization during embryo transfer have an impact on pregnancy rate in ICSI? : Tunisian preliminary results.

INTRODUCTION: Embryos' transfer into the uterine cavity remains a limiting factor in the success of intracytoplasmic sperm injection (ICSI). This study aimed to evaluate the impact of cervico-vaginal colonization on ICSI outcomes. MATERIEL AND METHODS: Longitudinal, prospective and analytical study, conducted from February 1 st to October 31 st, 2017. On the day of embryos' transfer, patients with the following criteria were included: Age ≤ 40, normal uterine ultrasound and hysteroscopy, first or second attempt of ICSI, use of fresh semen and transfer of at least one good quality embryo. Three samples were done for microbiological analysis: vaginal secretions, cervical mucus and the tip of the transfer catheter. RESULTS: The study included 40 patients. Pregnancy rate was 52.5 %. Catheter contamination occurred in nine cases (22.5 %). The most frequently isolated bacteria were Streptococcus anginosus (37 % of cases), Gardnerella vaginalis (27 % of cases) and Streptococcus agalactiae (18 % of cases). In all cases of contamination, the same bacteria were found also in the vagina and cervical mucus. In cases of contamination with Gardnerella vaginalis, the study of vaginal flora showed bacterial vaginosis. No pregnancy was obtained when contamination of the transfer catheter occurred. In the absence of contamination, pregnancy rate was 61.2 % (ρ = 0.003). Both populations (patients with catheter contamination and patients without catheter contamination) were comparable regarding epidemiological characteristics and ICSI attempt data. CONCLUSION: Contamination of the transfer catheter by cervical-vaginal bacteria appears to affect IVF results. Systematic antibiotic prophylaxis could be proposed to reduce this negative impact.

Survival of Escherichia coli strains in Mediterranean brackish water in the Bizerte lagoon in northern Tunisia.

This study investigated survival and virulence of Escherichia coli strains exposed to natural conditions in brackish water. Two E. coli strains (O126:B16 and O55:B5) were incubated in water microcosms in the Bizerte lagoon in northern Tunisia and exposed for 12 days to natural sunlight in June (231 to 386 W/m2, 26 +/- 1 degrees C, 30 g/L) and in April (227 to 330 W/m2, 17 +/- 1 degrees C, 27 g/L) or maintained in darkness for 21 days (17 +/- 1 degrees C, 27 g/L). The results revealed that sunlight was the most significant inactivating factor (decrease of 3 Ulog within 48 hours for the two strains) compared to salinity and temperature (in darkness). Survival time of the strains was prolonged as they were maintained in darkness. Local strain (E. coli O55:B5) showed better survival capacity (T90 = 52 hours) than E. coli O126:B16 (T90 = 11 h). For both, modifications were noted only for some metabolic activities of carbohydrates hydrolysis. Cytotoxicity of the two strains, tested on Vero cell, was maintained during the period of survival.

[Risk of vertical transmission of hepatitis B virus in Tunisia]. / Etude du risque de transmission verticale du virus de l'hepatite B en Tunisie.

The risk of vertical transmission of hepatitis B virus (HBV) varies with type of viral endemicity, degree of maternal infection and genomic characteristics of the virus. The aim of this study is to estimate this risk in Tunisia using serological and molecular methods to evaluate HBV replication, to determine viral genotypes and to detect presence of occult hepatitis in 2709 pregnant women. Serological markers were detected by ELISA methods, Genotype was determined by PCR-RFLP and occult hepatitis by nested-PCR. Four percent of women were positive for HBsAg; only 3% of them were also positive for HBeAg. Viral replication, over than 10(3) copies/ml, was detected in 61% of positive HBsAg patients. Three viral genotypes were detected: D (95%), B (3%) and A (3%). Occult hepatitis was detected in 4% of sera with "anti-HBc isolated" profile. In conclusion, the risk of vertical transmission of HBV exists in Tunisia. It increases by frequency of precore mutants, predominance of the genotype previously associated with high levels of replication and possibility of occult hepatitis B. These results show the importance of screening by serological HBV markers systematically during pregnancy with evaluation of viral replication in order to prevent vertical risk by efficient tools.

[Serological markers, viral RNA and genotype of hepatitis delta virus in HBs antigen positive Tunisian patients]. / Marqueurs sérologiques, ARN viral et génotype du virus de l'hépatite delta chez des patients tunisiens antigène HBs positifs.

OBJECTIVE: This study had for aim to study the serological and molecular patterns of hepatitis delta infection in Tunisian patients. DESIGN: Our study was carried out in 215 HBs antigen positive patients, including 176 asymptomatic carriers originated from regions of variable hepatitis B virus (HBV) endemicities, and 39 hepatitis B chronic patients with delta positive serology. Delta antigen, delta antibodies and HBe antigen were investigated for all patients; detection and genotyping of hepatitis delta virus (HDV) RNA and detection of HBV DNA were conducted in the second group patients. RESULTS: Twelve patients (6.8%) out of 176 asymptomatic carriers had HDV positive serology. Delta prevalence was relatively more elevated in regions of high HBV endemicity than on those with moderate or weak endemicity. The mean age of patients was 5 years higher in the delta positive subjects than in the global population. For hepatitis B chronic patients with delta positive serology, HDV RNA was detected in 53.8% of cases; HBV-HDV co-replication was observed in 38.4% of cases. Genotype 1 was found for one of the amplified samples. CONCLUSIONS: The results of our study enrich the limited data on HDV prevalence in Tunisia and on the molecular epidemiology of circulating isolates.

[Hepatitis B virus infection in Tunisian pregnant women: risk factors and viral DNA levels in HBe antigen negative women]. / Hépatite virale B chez les femmes enceintes tunisiennes: facteurs de risque et intérêt de l'étude de la réplication virale en cas d'antigène HBe négatif.

OBJECTIVE: To evaluate the seroprevalence and the risk factors of hepatitis B virus (HBV) infection in 2303 Tunisian pregnant women and to estimate the risk of perinatal transmission in women positive for hepatitis B surface antigen (HBsAg) but negative for hepatitis B e-antigen (HBeAg). MATERIAL AND METHODS: Positive samples were tested for HBeAg and anti-HBe antibody using enzyme immunoassays. Serum HBV-DNA was determined by real time PCR assay. RESULTS: Overall, 4% of women were HBsAg positive and for the majority of them (96.8%) this status was unknown. Only 1.4% of studied population were vaccinated previously against hepatitis B. Study of risk factors revealed association between the HBsAg status and presence of intrafamilial hepatitis cases (p<0.05). Only four women were positive for HBeAg. Among patients with HBeAg negative status, only 11% were negative for HBV DNA. For the others, DNA level ranged from 34 to 10(8)copies/ml; it was greater than 10(4)copies/ml in 26.5% of them. CONCLUSION: Hepatitis B virus (HBV) prevalence in pregnant women is of intermediate endemicity in Tunisia. Universal vaccination before pregnancy and antenatal screening is recommended. Pregnant women who are found to be HBsAg positive and HBeAg negative should be tested systematically for DNA level to evaluate the risk of perinatal infection and to prevent it by sero-prophylactic for babies or by treatment during the third trimester of pregnancy.

Genetic features of polioviruses isolated in Tunisia, 1991-2006.

BACKGROUND: Genetic characterisation of polioviruses remains highly important even in countries where wild poliovirus circulation has been interrupted. Sequence data on representative wild strains from all geographical regions is required for surveillance purposes and surveillance for vaccine-related isolates with increased potential for transmissibility in humans should continue. OBJECTIVE: To report the genetic characteristics of wild and vaccine-related polioviruses isolated in Tunisia from 1991 to 2006. STUDY DESIGN: Wild isolates were sequenced in the VP1 genomic region and compared to each other. Vaccine-related isolates were assessed for genetic recombination by PCR/RFLP and sequence analysis of the 3D region. Recombinant viruses were assessed for genetic drift in the VP1 region. RESULTS: The VP1 sequences of the last wild isolates, all from serotype3, showed 97.7-98.7% nucleotide homology. Nineteen percent of vaccine-related isolates were vaccine/vaccine intertypic recombinants. No recombinant with non-poliovirus enteroviruses was identified. Mutational differences in the VP1 sequences of recombinant viruses ranged from 0.0% to 0.7% indicating a limited replication period. CONCLUSIONS: This study provides sequence data on wild polioviruses from Tunisia/North Africa and shows that in countries with continuous high vaccine coverage transmission of vaccine-related polioviruses is time-limited.

[Bacteriospermia: Effects on semen parameters]. / La bactériospermie : effets sur les paramètres spermatiques.

OBJECTIVES: Bacteriospermia may result in male hypofertlity. Indeed, 60% of patients treated by Assisted Reproductive Techniques had a local infection or inflammation of genital tract. However, direct effects of bacteriospermia on semen parameters remain controversial. The aim of our work was to explore the effect of bacteriospermia on sperm parameters among patients consulting for hypofertility. METHODS: A retrospective comparative study of two groups: a group of 70 patients with bacteriospermia (group 1) and a control group of 70 patients without bacteriospermia (group 2). For these groups, we studied the standard semen parameters (seminal volume and viscosity and spermatozoa count, initial and secondary mobility, vitality and morphology). Comparison of these parameters was made by the Chi2 test and the Fisher test. RESULTS: The mean age of our population was 40.4±6.7 years. There was no significant difference between ejaculate average volume in the 2 groups (group B: 2.78mL versus group A: 2.92mL with P=0.2). Similarly, for the viscosity no difference was noted (P=0,68). The altered parameters in the presence of bacteriospermia were mean concentration and sperm motility (P=0.001 and P=0.049 respectively). The prevalence of secondary asthenospermia was higher in the presence of bacterospermia (P=0.006). No statistically significant differences were observed for morphology and vitality of spermatozoa (P=0.276 and P=0.075 respectively). The leucospermia was associated with bacteriospermia in 10% patients. Ureaplasma urealyticum was the germ most found (45.7%) followed by Streptococcus and Staphylococcacae (20.3% for each), Gram negative rods accounted for 12.9%, while Corynebacterium spp was isolated only in 4,3% patients. U. urealyticum was associated with hypospermia in 33% of cases (P=0.031). Spermatozoa motility was significatively decreased not only in the presence of this bacteria (FT=0.002) but also when cultures were positive for Streptococcus (0.04) and Corynebacterium (P<0.001). Morphological abnormalities were also noticed with Streptococcus with index of teratozoospermia of 46% versus 19% in the 2nd group (P=0.046). CONCLUSION: Bacteriospermia may impair sperm parameters. The treatment of this affection seems to improve sperm fertilizing potential. In addition, it could prevent contamination of culture media.

Molecular characterisation of a coxsackievirus A24 that caused an outbreak of acute haemorrhagic conjunctivitis, Tunisia 2003.

This study reports the genetic characteristics of coxsackievirus A24 isolates from Tunisia, including a coxsackievirus A24 variant (CVA24v) that caused an outbreak of acute haemorrhagic conjunctivitis (AHC) between September and November 2003. The virus genome was detected by PCR from conjunctival swabs obtained from patients with AHC. Four virus isolates were obtained from PCR-positive samples and were serotyped by sequence analysis of the VP1 and VP4 genomic region and by seroneutralisation. Phylogenetic analysis of the VP1, VP4 and 3C genomic regions was performed. Other Tunisian CVA24 isolates from paralytic cases and healthy individuals were also amplified, sequenced and included in the phylogenetic analysis. The epidemic strain belonged to the CVA24 serotype. Phylogenetic analysis of the 3C region of the genome revealed a strong relationship between the Tunisian epidemic strain and strains that caused outbreaks in Korea (2002) and Guadeloupe and French Guiana (2003). Phylogenetic analysis of the VP1 and VP4 regions showed a clear distinction between serotype CVA24 isolates from conjunctivitis and non-conjunctivitis cases. This is the first study to report an outbreak of AHC caused by CVA24v in the North African region.

Genomic stability prevails in North-African hepatocellular carcinomas.

The molecular pathogenesis of hepatocellular carcinoma, a tumour characterized by a vast clinical heterogeneity, remains unexplored outside Europe and Eastern Asia. We analysed by direct sequencing or loss of heterozygosity assay, the common targets of genomic alterations in 42 hepatocellular carcinomas collected in western North-Africa. Overall, genomic instability was uncommon, allelic losses affecting mostly chromosomes 1p, 4q, 8p and 17p (24-28% of cases). CTNNB1 and TP53 were infrequently mutated (9 and 17% of cases, respectively). Surprisingly, TP53 mutation R249S, diagnostic of aflatoxin B1 exposure, usually frequent in Africa, was exceptional (one case), indicating that in western North-Africa, hepatocellular carcinoma genetics differs markedly from that of the remainder of the continent.

A case control study to assess risk factors for hepatitis C among a general population in a highly endemic area of northwest Tunisia.

A matched case-control study was undertaken in 2004 in Béja, north-western Tunisia, to evaluate potential risk factors for hepatitis C infection. Cases were anti-HCV positive subjects screened in 1996 serosurvey. HCV seronegative controls (5 per case) were selected in the proximity of cases and matched for age and gender. A standardized questionnaire was used to collect demographic, socioeconomic, social behavior, medical and surgical history information. Matched odds ratios (OR) and adjusted OR (AOR) and their 95% CI were calculated in multivariate analysis using logistic regression. 57 HCV positive cases (mean age 61.63 +/- 14,84; 68.4 % female) and 285 HCV negative controls (mean age 60.95 +/- 14.66; 68.4 % female) were enrolled. Multivariate analysis revealed that intravenous drug injections (AOR=1.96; 95%CI[1.02-3.8] p=0.045), past history of invasive procedures (AOR=2.53; 95%CI[1.21-5.29] p=0.0014) and medical history of hypertension (AOR=2.31; 95%CI [1.17-4.56]p=0.015) were significantly associated to HCV infection. These results suggest that nosocomial transmission of HCV infection in north-west Tunisia is common.

Enteroviruses in Tunisia: virological surveillance over 12 years (1992-2003).

This report is an overview of enterovirus epidemiology in Tunisia during a 12-year period from 1992 to 2003. A total of 4700 clinical samples were collected as part of the national poliovirus surveillance programme and the routine diagnostic programme for aseptic meningitis. Enterovirus detection was performed by isolation on cell culture according to World Health Organization recommended protocols. Serotype identification was performed by seroneutralization of the cytopathic effect using pools of specific antisera and sequencing in the VP1 region of the genome. Poliovirus isolates were assessed for their wild or vaccine-related origin by standard World Health Organization recommended methods (PCR, probe hybridization and ELISA). The results confirm the interruption of wild poliovirus circulation since 1995. A total of 236 non-polio enterovirus (NPEV) strains were isolated; seroneutralization allowed typing of 93 % (219 out of 236) of them. The antisera used allowed the identification of the most common enterovirus serotypes. The remaining 17 isolates were sequenced; 16 of them belonged to enterovirus serotypes that were not targeted by the antisera pools used. A total of 29 different serotypes of NPEV were detected in the country during the study period. Echoviruses of serotypes 6, 11 and 30 were the most frequently isolated, almost every year; other serotypes had a cyclic occurrence and others were detected during a limited period with very few isolates. The NPEV isolation rate varied from year to year but was steadily under 10 %, suggesting a relatively low prevalence of these viruses in comparison to that in other developing countries. A seasonal variation was also noted; the high transmission period starts in March and peaks in September-November. This study is the first report of the epidemiology of NPEV in Tunisia. These viruses are associated with various diseases and epidemiological data may help to clarify their impact on human health.

[Blood-transmitted viral infections among haemophiliacs in Tunisia]. / Infections par des virus transmissibles par le sang chez des hémophiles en Tunisie.

In this work, we proposed to evaluate prevalences of hepatitis B and C viruses and Parvovirus B19 among 70 Tunisian haemophiliacs treated with clotting factors imported from Europe and/or locally produced cryoprecipitate; among them 6 (8.6%) are known HIV positive patients. HBs antigen, anti-HBc antibodies and anti-Parvovirus B19 antibodies were detected in 7.1%, 52.9% and 91.8%, respectively. HCV prevalence, defined as positive ELISA with positive Immunoblot and/or PCR was 50.0%. Prevalences of these viral infections in haemophiliacs are higher than prevalences detected among general population and in the control group of the study. HCV infection is less frequent in haemophiliacs born after 1985, the year of introduction of the inactivation procedures in the production of coagulation factors concentrates; it decreases more considerably after 1994, date of introduction of systematic screening of HCV among blood donors. In contrast, despite the inactivation of the factors concentrates and the systematic screening of the blood donations against HBs antigen, since 1973, the risk of HBV infection contamination remains high in the Tunisian haemophiliacs. The introduction in 1995 of hepatitis B vaccination in the national schedule of new-born vaccination may resolve in the future the problem of HBV infection in haemophiliacs and in the other categories of the Tunisian population.

Molecular epidemiology of poliovirus infection in Tunisia.

This report is an overview of poliomyelitis surveillance in Tunisia from 1991 to 1996. In all, 2088 stool specimens, collected from 152 acute flaccid paralysis (AFP) cases and from 1747 of their healthy contacts were investigated. Virus isolation was done systematically in RD and HEp-2C cell lines and isolated viruses were typed by sero-neutralisation as polioviruses or non-polio enteroviruses. Poliovirus isolates were analysed systematically for their wild or vaccine-related origin by two methods--one based on antigenic differences and one on genetic differences between strains. All type 2 polioviruses were vaccine-related and most wild viruses belonged to polio serotype 3. Wild polio type 3 viruses were detected in 1991 and 1992 in six cases of paralytic polio. A silent circulation of wild polio 1 and wild polio 3 was detected in 1994. No wild virus was detected in Tunisia from 1995 onwards. Wild polioviruses were sequenced and compared with Tunisian wild strains isolated during the 1980s, as well as other genotypes from the international database. These investigations revealed a single Tunisian polio 3 genotype that has been circulating from 1985 to 1994 and two different polio 1 genotypes. These results reflect effective control strategies within the country and contribute to the improvement of the polio eradication programme effectiveness at national and global levels.

[West Nile viral meningo-encephalitis in Tunisia]. / Méningo-encéphalite à arbovirus West Nile en Tunisie.

In autumn 1997 an epidemic outbreak of meningoencephalitis was observed in two coastal districts of Tunisia. A total of 173 cases were recorded with 8 deaths. Detection with IgM capture and indirect IgG ELISAs demonstrated West Nile virus infection in 86% of patients from whom specimens were collected. West Nile is endemic in Asia and Sub-Saharan Africa. Epidemics in humans and horses have also been reported in the Mediterranean region and southern European countries. However this is the first report in Tunisia. Special West Nile virus surveillance is necessary especially in countries at high-risk for repeated introduction of this arbovirus.

[Role of enteroviruses in aseptic meningitis in Tunisia]. / Place des entérovirus dans les méningites aseptiques en Tunisie.

Despite the favourable clinical outcome in most cases, viral meningitis can cause a serious public health problem especially when several cases occur during outbreaks. The first part of this work is a retrospective study conducted in three hospitals in Tunisia and covering a period of three years. It showed an incidence of viral meningitis 2.4. The second part of the study is a prospective one, it included 94 cases of aseptic meningitis notified during a period of 12 months. Virus isolation in cell culture was performed on CSF and stool samples, using cell lines sensitive to enteroviruses. A PCR to detect enteroviruses was also used in parallel. This study represents a first approach to viral meningitis in Tunisia. It highlights the importance of a regular surveillance of the disease and the contribution of molecular methods to a more sensitive diagnostic. However, cell culture remained necessary for viral isolation and serotyping.

[Retrospective study of viral causes of central nervous system infections in Tunisia (2003-2009)]. / Étude rétrospective des étiologies virales des infections neuroméningées en Tunisie (2003-2009)

OBJECTIVES: To determine the role of enteroviruses, Herpesviridae, West Nile virus and Sandfly Toscana virus in central nervous system (CNS) infections in Tunisia. METHODOLOGY: 847 cerebrospinal fluid (CSF) samples, 427 serum samples and 23 stool samples were collected from 1071 patients hospitalized for CNS viral infections from January 2003 through December 2009. All CSF samples were first tested by PCR to detect enteroviruses and Herpesviridae. In specific epidemic contexts in patients negative for these viruses, arbovirus infection was tested by ELISA. RESULTS: Virological testing was positive in 17.5% of cases. West Nile virus and enteroviruses accounted for 58% of them, enteroviruses 23.5%, Herpesviridae 8.5%, and Toscana virus 10%. West Nile virus infection was observed only in 2003, during an outbreak in coastal regions. Toscana virus circulated regularly throughout the study period. Enteroviruses were responsible for grouped cases of aseptic meningitis in both 2003 and 2005. Arboviruses and enteroviruses were detected mainly in summer and autumn. Herpesviridae were associated with sporadic cases of meningoencephalitis. CONCLUSION: This report on viral causes of CNS infections in Tunisia shows that West Nile virus and enteroviruses appear to circulate mainly during epidemics, while the circulation of Toscana virus seems continuous. Negative virus findings may be due, at least in part, to late sampling, inappropriate sample collection and transportation to the virology lab, or failure to test for the right virus. It is essential to promote collaboration between clinicians and biologists to maximize the likelihood of diagnosis.

[Second epidemic of West Nile virus meningoencephalitis in Tunisia]. / Une deuxième épidémie de méningo-encéphalite à virus West Nile en Tunisie.

UNLABELLED: The West Nile virus (WNV) re-emerged in Tunisia in 2003, causing an outbreak of meningoencephalitis. OBJECTIVE: The authors studied the epidemiological, clinical, biological, and imaging features of WNV-associated neurological disease observed in central eastern Tunisia. DESIGN: A retrospective descriptive study was made on patients with West Nile meningitis and/or encephalitis observed in the Sousse area, from August 15 to November 15, 2003. Screening for specific anti-WNV antibodies in serum was performed with Elisa. RESULTS: Recent central nervous system infection due to WNV was confirmed in 21 patients with a mean age of 53 years and a sex ratio of 3.2. The clinical presentation was meningitis in 11 cases, meningoencephalitis in seven cases, and encephalitis in three cases. Patients with encephalitis were older than those with meningitis. An acute flaccid limb paralysis was observed in three patients. The CSF assay showed lymphocytosis, high protein (67 %), and normal glucose levels (83 %). Brain CT scan and MRI were normal. Three patients died, the remaining evolved uneventfully. CONCLUSIONS: These first cases of WNV meningoencephalitis in Sousse area suggest a possibility of reemergence of this infection. Preventive measures and epidemiological surveillance are necessary.