[Symmetrical peripheral gangrene: 4 cases]. / La gangrène périphérique symétrique : à propos de 4 cas.

BACKGROUND: Symmetric peripheral gangrene (SPG) is a symmetrical distal ischemic lesion on at least 2 or more extremities in the absence of proximal arterial obstruction and vasculitis. It is a rare and severe clinical entity. The aim of this study was to describe clinical symptoms, etiological agents and the management of SPG through a series of 4 cases. PATIENTS AND METHODS: We included all cases of SPG hospitalized between 2000 and 2014. The inclusion criterion was the presence of distal ischemic damage at two or more sites in the absence of large vessel obstruction. RESULTS: Four patients (2 men and 2 women) were included. The mean age was 43.2±12 years. Two patients had a history of splenectomy. All patients had blackening of the tips of the fingers and toes. Three patients presented with septic shock. The etiology was bacteremia involving Streptococcus pneumoniae in two cases and a malignant form of Mediterranean spotted fever (MSF). In addition to specific antibiotics, we used a potent vasodilator (iloprost) in two cases and curative heparin therapy in two cases. The outcome was favorable in 3 cases, with regression of necrotic lesions. One case required the amputation of non-perfused necrotic fingers and toes. CONCLUSION: SPG can complicate MSF in some rare cases. Thorough and repeated skin examinations are essential to ensure timely diagnosis and treatment of GPS in order to improve the prognosis.

The ongoing challenge of Pulmonary Tuberculosis in Southern Tunisia: A review of a 22-year period.

BACKGROUND: Despite the wide use of anti-tuberculosis drugs, pulmonary tuberculosis (PTB) remains one of the most important causes of mortality and morbidity, particularly in developing countries. Therefore, combining clinical and epidemiological approach would be of a great benefit. Our study aimed to describe the epidemiological and clinical specificities of PTB and its recent chronological trends. METHODS: We conducted a retrospective study of all PTB new cases of any age diagnosed between 1995 and 2016 in Southern Tunisia. We applied the direct method of age-standardization using the World Standard Population to compute the age standardized incidence rate (ASIR) and the age standardized mortality rate (ASMR) per 100 000 inhabitants. RESULTS: We recorded 1121 new cases with PTB among 2771 new cases of tuberculosis (40.5%). The ASIR of PTB was 5.3/100 000 inhabitants/year and didn't change over the study period (rho=0.3; P=0.2). Patients with PTB were mainly aged between 15 and 59 years (n=861; 76.8%) and came from urban areas (n=600; 55%). The median duration of treatment was 7.6 months (IQR=[6-8 months]). Successful outcome was notified in 1075 cases (95.9%). Forty-one patients died yielding an ASMR of 0.18/100 000 inhabitants/year. Factors statistically associated with unsuccessful outcome included age≥60 years (OR=5; P<0.001) and shorter treatment duration (6.15 months vs 7.76 months; P<0.001). CONCLUSION: In contrast to the decline in the global PTB incidence reported worldwide and in the neighboring countries, our study revealed no significant change in the PTB rates from 1995 to 2016. Therefore, tools and strategies used to manage PTB should be strengthened by a substantial effort in both basic science and epidemiology to have better incidence curves.

[Ocular tuberculosis : A case series]. / La tuberculose oculaire : une série de 14 cas.

OBJECTIVES: Ocular tuberculosis is a rare form of extra pulmonary tuberculosis. It represents 1-2% of all clinical forms. The aim of this work was to focus on diagnostic and therapeutic characteristics of ocular tuberculosis. METHODS: We report a case series of 14 patients with ocular tuberculosis seen in an infectious diseases department between 2006 and 2015. The diagnosis was retained on clinical data and a positive tuberculin skin test or interferon-gamma release assay. RESULTS: The patient's mean age was 40.7±9years. The most common clinical presentation was uveitis (11 patients and 16 eyes). An extra ocular involvement was associated in three patients. The mean duration of antitubercular therapy was 10±2.5 months. Corticosteroid therapy was associated in 11 cases. The outcome was favorable in all cases. Two patients had maintained visual sequelae. CONCLUSION: Ocular tuberculosis is a rare disease but still remains a diagnostic problem. It should be considered in case of any chronic ocular symptoms, especially in endemic countries. Early management can improve the visual prognosis.

[Melitococcal psoas abscesses: study of three cases and review of the literature]. / Les abcès mélitococciques du psoas: etude de 3 cas et revue de la litterature.

Vertebral involvement is a common complication of brucellosis in adults. However psoas abscess related to brucellar spondylitis have rarely reported. The purpose of this report is to describe three cases of bilateral psoas abscess identified during workup for brucellar spondylitis. Medical imaging was helpful in confirming diagnosis of these fluid collections. Epidemiological, clinical, radiological and serological findings were consistent with melitococcal etiology. Treatment was based on a combination of antibiotics (rifampicine-doxycycline) and abscess evacuation by percutaneous drainage, needle aspiration or open surgery. Outcome was favourable. Brucellar psoas abscess is uncommon. Most caseare discovered coincidentally during investigation of melitococcal spondylitis. Management usually consists of fluid drainage and appropriate antibrucellar therapy. Prognosis is favourable.

[Staphylococcus aureus meningitis with intermediate sensitivity to glycopeptides. Therapeutic indications]. / Méningite à Staphylococcus aureus de sensibilité intermédiaire aux glycopeptides. Implications thérapeutiques

INTRODUCTION: Since 1997, several observations of glycopeptide intermediate Staphylococcus aureus (GISA) infections have been described. We report the case of meningitis. OBSERVATION: A 46 year-old man was treated surgically on several occasions for a meningioma of the back cranial fossa. Intracranial hypertension required the placing of a cerebrospinal leading-catheter. He developed a GISA meningitis. Antibiotics and removal of the catheter cured the infection. DISCUSSION: To our knowledge, this is the first observation of GISA meningitis. Such infections are rare and are probably underestimated due to the lack of standardized detection methods. They occur in fragile, surgical, immunodeficient patients, often living with prostheses. Prior treatment with vancomycine is often reported. The emergence of these infections is a serious therapeutic problem, since vancomycine is a major antibiotic used in the treatment of meticillin-resistant S. aureus (MRSA) infections.

[Diagnosis of peripheral tuberculous lymphadenitis in Tunisia]. / Diagnostic de la tuberculose ganglionnaire périphérique en Tunisie.

OBJECTIVE: The aim of the study was to evaluate the contribution of microbiology, cytology, and anatomopathology in 50 cases of peripheral tuberculous lymphadenitis. METHODOLOGY: Our patients underwent bacteriological tests and cytology and/or histopathology for lymphadenitis. RESULTS: Ziehl-Neelsen stains and cultures were positive in only 29.7% and 10.8% of cases respectively. The diagnosis was confirmed by cytology in 31.3% of cases (10/32) and by histology in 58.6% of cases (27/46). Granulomas were observed in 46.8% (15/32) of needle aspirates and 76% (35/46) of surgical biopsies. CONCLUSION: Our study reveals a weak contribution of conventional microbiological techniques. Cytology remains the procedure of choice in endemic countries. Excisional biopsy may be performed in case of doubt.

Les effets indesirables dus aux antibiotiques : etude retrospective sur trois ans au centre regional de pharmacovigilance de Sfax

Les effets indesirables aux antibiotiques constituent un reel probleme de sante publique. Dans ce travail; ont ete analyses la frequence; les types; les facteurs predisposant et la gravite des effets indesirables aux antibiotiques. Notre etude; de type retrospectif; porte sur les cas d'effets indesirables aux antibiotiques obtenus par notification spontanee au centre regional de pharmacovigilance de Sfax durant une periode de trois ans. Parmi 249 cas d'effets indesirables medicamenteux; 82 cas (32;93) ont ete lies aux antibiotiques. L'age variait de 5 a 86 ans. Il s'agissait de 55 femmes et de 27 hommes. Soixante dix effets indesirables lies aux antibiotiques (85.36) parmi 82 etaient de nature immunoallergique. Dans 60 cas (73.17); les patients avaient des antecedents medicaux: atopie; allergie medicamenteuse; maladies auto-immunes ou pathologies chroniques necessitant une polymedication. 54 patients (65.85) prenaient 3 medicaments ou plus. Les formes graves ont ete observees chez 12 patients parmi 82 (14.63). La polytherapie; les maladies chroniques et l'age avance sont des facteurs favorisant la survenue des effets indesirables aux antibiotiques. Nos resultats soulignent le risque augmente chez les sujets ayant un antecedent d'allergie a un antibiotique de developper une allergie a un autre antibiotique

Particularites des infections invasives a streptocoque du groupe B de l'adulte

Une augmentation de l'incidence des infections invasives a streptocoque du groupe B (SGB) de l'adulte a ete notee dans plusieurs pays developpes. Tres peu de series decrivent la situation dans les pays en voie de developpement. Objectifs : Determiner les particularites epidemio-cliniques; les facteurs favorisants et les modalites evolutives de ce type d'infections observees dans un hopital tunisien.Methode : Analyse retrospective de 65 episodes suivis entre 1993 et 2007. Resultats : Le sex-ratio etait de 0;3 et la mediane des ages etait de 59 ans. Au moins un facteur favorisant etait note dans 73;8des patients. Ces facteurs etaient domines par le diabete et les infections urinaires recidivantes (25). Les urosepsis; les infections genitales et les bacteriemies sans foyer primitif evident dominaient les tableaux cliniques. Les infections etaient polymicrobiennes dans 13;9des cas. Tous les isolats de SGBetaient sensibles aux penicillines. L'evolution etait souvent favorable; 4;6des patients etaient decedes et 7;7avaient eu des recidives d'infections invasives au meme germe. Conclusion : Notre etude montre un spectre clinique particulier des infections invasives a SGB de l'adulte et confirme le role du terrain sous jacent dans ce type d'infection. Une etude tunisienne a plus large echelle permettra de preciser l'ampleur de ces infections dans notre pays