[Antibiotic therapy for diabetic foot infections]

Foot infections in patients with diabetes cause substantial morbidity and may lead to amputation. Diabetic foot infections require attention to local and systemic issues and coordinated multidisciplinary management. Aerobic gram-positive cocci, especially S. aureus, are the predominant pathogens. Patients with chronic wounds or who have recently received antibiotics may also be infected with gram-negative or anaerobic pathogens. Wound infections must be clinically diagnosed on the basis of local signs and symptoms of inflammation. Specimens appropriately obtained must be sent for culture prior to starting empirical antibiotic therapy. Tissue specimens obtained by biopsy, ulcer curettage, or drainage are preferred. Infections should be categorized by their severity to determine the degree of risk and the urgency of management. Empirical antibiotic therapy is selected on the basis of the severity and the likelihood of etiological agents. Therapy aimed solely at aerobic gram-positive cocci may be sufficient for mild-to-moderate infections in patients who have not recently received antibiotic. Definitive therapy should be based on the susceptibility data and the clinical response to the empirical regiment. Severe and some moderate infections require pareteral therapy, at least initially. Highly oral bioavailable antibiotics can be used in most mild and moderate infections. Antibiotic therapy should be continued until there is evidence that the infection has resolved but not necessarily until a wound has healed. Surgical evaluation is needed for infections accompanied by a deep abscess, extensive bone or joint involvement, substantial necrosis or gangrene, or necrotizing fasciitis

[Six cases of actinomycosis]

Actinomycosis is a rare granulomatosis infection caused by anaerobic bacteria; Actinomyces. There are many locations of actinomycosis and they can simulate an inflammatory or malignant process or pyogenic infection. We report 6 cases of actinomycosis. The diagnosis was confirmed by an anatomopathologic exam. The evolution was marked by an improvement after prolonged antibiotic treatment. This study shows the difficulties in the diagnosis of actinomycosis and the importance of systematic histopathological examination

[First four cases of acute meningitis due to Toscana virus on monastir region]

Toscana virus [TOSV] has been identified as an important cause of acute meningitis in Italy where it was isolated for the first time. Currently, it is one of the major viral pathgens involved in acute meningitis in Mediterranean countries. We describe four cases of acute meningitis caused by TOSV concerning patients hospitalized in the department of infectious diseases, Fattouma Bourguiba university hospital, Monastir [Tunisia]. The demographic data, the clinical and laboratory features and the evolution were reviewed. All patients were male, living in coastal region. They were hospitalized in summer period. The mean age was 26 years. The diagnosis was suspected in the presence of fever and acute meningitis syndrome. Lumbar puncture showed clear cerebrospinal fluid [CSF] containing normal glucose and predominant lymphocyte. This diagnosis was confirmed by detection of anti-TOSV IgM in blood and CSF. The outcome was favorable in all cases. No specific treatment was administered. The mean follow-up was nine months

Intestinal strongyloidiasis rebelled at albendazole in immunocompetent patient: a case report

Interest of ivermectine in Strongyloides stercoralis infection rebelled at a treatment by albendazole. We report an intestinal infection case of Strongyloides stercoralis in 60-year-old immunocompetent women. The diagnosis of Strongyloides stercoralis was suspected on clinical parameters and performed by parasitologic analysis of feces. The outcome was defavourable under treatment by albendazole. Although, clinical and laboratory findings resolved after ivermectine therapy. Ivermectine is the main treatment in intestinal strongyloldiasis rebelled at treatment by albendazol

Facial cellulitis as a complication of a periradicular abscess due to Gemella morbillorum

Gemella morbillorum is a facultatively anaerobic Gram-positive coccus which forms part of the normal flora of the oro-pharynx, the upper respiratory and gastrointestinal tracts. It rarely causes human infection, more often in immunocompromised hosts. We report a case of periradicular abscess due to Gemella morbillorum occurring in a young immunocompetent adult and review previous reports of infections due to Gemella morbillorum in the literature

[Breast tuberculosis: study of 15 cases]

Mammary tuberculosis is a rare disease especially seen in underdeveloped countries. Describe the epidemiological, clinical parameters of mastitis tuberculosis and determinate the interest of imagery and histology in diagnosis. Fifteen cases of tuberculous mastitis diagnosed at the Infectious Diseases and Gynaecology departments of F. Bourguiba hospital during the period from January 1988 to March 2006. The mean age of our patients was 29.2 years [21 - 56 years]. History of tuberculosis was found in 33.3% of the cases. Sixty percent presented with fever and 73.4% complained of skin abscess. We noted symptoms of tuberculosis impregnation in 53.3% of cases. The fine needle aspiration achieved for all patients was negative in 14 cases and brought back the caesium in the other. The diagnosis has been made, for all our patients, after histological study when we found typical tuberculosis lesions on pieces of tumorectomy or biopsy. All patients had an anti-tuberculosis medical treatment. The median duration of treatment was 10 months [9 -18 months]. Although tuberculosis of breast is extremely rare, it should be kept in mind particularly in undeveloped countries. In front of symptoms evoking tuberculosis, biopsies must be done to eliminate an eventual cancer