Neonatal purulent meningitis in southern Tunisia: Epidemiology, bacteriology, risk factors and prognosis.

OBJECTIVES: To study the epidemiological, clinical and bacteriological aspects and outcome of purulent neonatal meningitis (PNM). METHODOLOGY: Retrospective analysis of 55 cases of PNM hospitalized in the pediatric ward of Hedi Chaker Hospital from 1990 to 2012. Infants less than 29 days of age were included. The diagnosis was made on either the presence of bacteria in the cerebrospinal fluid (CSF) or the combination of pleocytosis >30 cells/mm(3), protein level >1.3 g/l and glucose level <2.2 mmol/l or CSF/blood glucose ratio <0.4. RESULTS: The male:female sex ratio was 1.75. One or more maternal risk factors for infection were found in 24 cases. The main symptoms were fever and poor feeding. Soluble antigen was positive in four cases and cultures had isolated the bacteria in 28 cases. The mortality rate was 40%. The sequelae rate in the survivors was 16.4%. CONCLUSION: This study emphasizes the severity of PNM with high rates of mortality and neurological sequelae.

Predictive Factors of Febrile Neutropenia Induced by Anticancer Chemotherapy in the South of Tunisia.

INTRODUCTION: Febrile Neutropenia (FN) secondary to chemotherapy is the most common and the earliest hematological complication. The aim of this work is to study the predictive factors of FN. Materiel and Methods: This is a retrospective study including 186 episodes of FN induced by chemotherapy treated in the department of oncology at Sfax in southern Tunisia during the period between 1 January 2006 and 31 December 2010. RESULT: The mean age of patients was 40 years. One hundred and seventeen patients had solid tumors (86.02%), 18 patients (13.23%) had hematological malignancies and one patient was treated for hypo pharyngeal cancer and aplastic Anemia. Chemotherapy was indicated for curative purpose in 94 cases and palliative purpose in 92 cases. One hundred and four patients (76.5%) had a single episode of FN and 32 (23.5%) had at least two episodes. The average time of febrile neutropenia was 11 days. CONCLUSION: Personal history of FN, poor performance status, chemotherapy regimen and the stage of the disease increased the risk of FN, with a statistically significant difference. Other factors such as hematological malignancies, the age over 65 years and concurrent chemo radiotherapy were not retained in our series.

[Antibiotic sensitivity of Streptococcus pneumoniae in Tunisia: results of a multicenter study (1998-1999)]. / Sensibilité aux antibiotiques de Streptococcus pneumoniae en Tunisie: résultats d'une étude multicentrique (1998-1999).

We report the results of a multicenter tunisian study, performed over a two-year period (1998-1999), to determine the susceptibility pattern of Streptococcus pneumoniae in our country. A total of 146 S. pneumoniae were collected during the study period. 76 were recovered from adults and 70 from children. 53% of isolates have decreased susceptibility to penicillin, 24% with low level resistance, and 11% with high level resistance. Amoxicillin and cefotaxime decreased susceptibility rates were: 12% (low level resistance exclusively). and 14% (10% with low level resistance and 4% with high level resistance) respectively. Strains isolated from children, showed higher resistance to b lactams than those isolated from adults. Resistance rates to other antibiotics were as follow: erythromycin 28%, choramphenicol 14%, cyclins 23%, thrimethoprim-sulfamethoxazole 28% and rifampin 1%. No vancomycin resistant strain was found. The acquire resistance rates of Streptococcus pneumoniae in Tunisia are worrying, essentially for penicillin and erythomycin. Amoxicillin and cefotaxime have conserved a good activity.

Resistance to macrolides by ribosomal mutation in clinical isolates of Turicella otitidis.

The genetic basis of erythromycin resistance in Turicella otitidis, a coryneform bacteria associated with otitis, was studied in five macrolide-resistant clinical isolates. Macrolide resistance genes were searched for by polymerase chain reaction (PCR). Genes for domain V of 23S rRNA (rrl) as well as rplD (L4 protein) and rplV (L22 protein) genes were characterised, amplified by PCR from total genomic DNA and sequenced. In the resistant isolates, cross-resistance to macrolides and clindamycin was associated with mutations at positions 2058 and/or 2059 (Escherichia coli numbering). Three isolates displayed A2058 mutations, one isolate had an A2059G mutation whereas another one contained mutations at positions 2058 and 2059. Southern blot experiments revealed that T. otitidis had three copies of the rrl gene. In conclusion, resistance to macrolides in T. otitidis is due, at least in part, to mutations in the rrl gene.