[Intestinal parasites in food handlers region of Tunis: 8502 study stool samples [1998-2008]]

The food handlers control is one of the major measures of the National program against intestinal parasitoses in Tunisia. The collected data allow regular updates of the prevalence and profile of the involved parasitic species and note possible evolutions in time. From 1998 to 2008, 8502 stool samples of food handlers working in Tunis area were examined in the laboratory of Parasitology, Pasteur Institute of Tunis. The mean prevalence of intestinal parasites was 13.5% [1152 positive samples]. The protozoa were the most detected parasites [93% of the species observed]. Among the pathogenic or potentially pathogenic parasites, Dientamoeba fragilis [15.5%] and Giardia intestinalis [7.6%] were the most frequently encountered. Entamoeba [E.] histolytica/dispar was diagnosed in 41 subjects [a prevalence of 0.5%]. Hymenolepis nana was the most frequent helminth [4.5% of the whole parasites]. Therapeutic failures were noticed in 43.8% of infection by this cestode because of the lack of the appropr iate antihelminthic. The identification using PCR of cysts and/or vegetative forms of E. histolytica/dispar revealed the exclusive presence of E. dispar

Current epidemiological, clinical and parasitological data concerning cutaneous lesishmaniasis in Tunisia

In order to update the geographical distribution of the three noso-geographical of cutaneous leishmaniasis [CL] occurring in Tunisia, namely the sporadic [SLCL zoonotic [ZCL] and chronic [CCL] forms, and to review their main pattern, a involving 244 cases, was carried out. Most of patients were infected in the Central and Southern parts of the country 74.2% and suffered of ZCL in 64.8% of cases. The three forms were registered in zones considered so far as preserved thus confirming their geographical spread. Sexes were equally affected [sex ratio: 1.02]. The patients were predominantly children and young] adults aged 24.6 years on average. ZCL lesions were mainly multiples [54.1%] localised in the limbs [81.5%] while those of SCL were rather isolated [91%, p<001] and affected the face [84.3%, p<0,00l]. Two clinical presentations prevailed: the classical ulcerous presentation with scabs in ZCL [72%] and the erythematous presentation in SCL [55,9%, p=0.002]. A negative correlation was found between the number and duration of the lesions on presentation [r=0, 22; p<0,00l]. The iso-enzymatic identification of 105 isolated strains confirmed that L. major was the most prevalent species [60.9%] followed by L. infantum [27.6%] and L. killicki [11.4%]. Within L. infantum complex, zymodeme MON-24 was prevailing [75,9%]. CL remains an emergent disease in Tunisia with an incidence and a geographicol spread continuously on the increase. Recent environmental changes, auspicious to Phlebotomine vectors and rodents reservoirs, had probably contributed to that situation

Contribution of the real time PCR in antenatal diagnosis of congenital toxoplasmosis

The antenatal diagnosis of congenital toxoplasmo-sis rests in Tunisia on ultrasonography coupled with biological explorations. Among these explorations the search of Toxoplasma gondii by means of real time PCR in amniotic fluid is the examination of choice. We report the results of 33 parturients for which the biological examinations allowed to retain the notion of perigravidic or per-gravidic toxoplasmic infection. They were 13 patients having a seroconversion during the pregnancy, 19 having anti-toxoplasmic IgM with a low or intermediate index of avidity and a patient having presented a symptomatic anteconceptional primary infection. The ADN was extracted by means of the Kit [Qiagen]. Genie amplification by PCR TaqMan targeted a portion of 71 pairs of bases of the Bl gene. The PCR was positive among 9 patients [27,3%]. They were a patient having presented a symptomatic toxoplasmosis during the pregnancy, 4 patients having consulted only in the 2nd quarter and for which the index of avidity was intermediate and 4 patients having presented seroconversions of 1st [n=l] of 2nd [n=2] or 3rd trimester. Among these patients, 2 had a medical interruption of pregnancy. The 7 others were put under pyrimethamine sulfadiazine. The neonatal assessment practised at 5 new-born babies was negative in all the cases. The PCR was negative for 24 patients. 18 pregnancies were followed. The neonatal serology was negative. The follow-up of 13 newborn child showed the disappearance of the anti-toxoplasmic IgG between the 6th and 12th month

[Value of screening for intestinal and urinary parasites in non-resident permanent students in Tunisia]

In order to fight digestive and urinary parasitoses, a national program of surveillance has been founded. The screening of these parasitoses among the non permanent resident students in Tunisia [ENRPTS] is one of the main actions of this program. Among 2560 ENRPTS tested in the laboratory of Parasitologie of Institut Pasteur of Tunis, between 1998 and 2002, 674 were infected by parasites, which represents a global prévalence of 26.3%. The intestinal protozoa constitute the majority of parasites identified [87.4%]. Entamoeba histolytica has been isolated in 89 cases, essentially from students from tropical African countries. Urinary bilharziosis has been diagnosed in 25 cases. These results confirm the utility of the control of the ENRPTS. The precocious tracking permits to avoid the introduction and the dissemination of parasites already absent or rare in our country

[Importance of amastigote forms morphology to differentiate Leishmania infantum and Leishmania major species]

The microscopic study of the dermal smears of 62 cases of cutaneous leishmaniose, 27 infected by Leishmania [L.] infantum and 35 by L. major, showed that the amastigotes of L. infantum are meaningfully smaller [p < 0.001]. This criteria is a simple pary alternative to distinguish these 2 species which have completely different epidemiology, recovery delay and prophylactic dispositions