Bacteriological and therapeutic profile of diabetic foot infection: a prospective study of 100 patients

Introduction: Identifying the infecting bacterial flora is one of the main rules to be followed to ensure the success of antibiotherapy in the treatment of the infected diabetic foot

The aim of the work was to define the bacteriological profile of the bacteria causing the infection of the diabetic foot at the surgery unit B of Charles Nicolle's hospital in Tunis and determine the prognostic factors of this condition

Methods: It was an open prospective study. It concerned 100 diabetic patients operated on for diabetic foot infection. All patients had bacteriological samples taken through deep scraping and swabing carried out in the operating room

Results: The average age of patients was 59,5 +/- 11 years, with a sex-ratio of 2,4. The foot infection was represented in 82 % of cases by a wet gangrene. The enterobacteria were the most frequently isolated bacteria [73%], followed by streptococcus [10%], Staphylococcus aureus [9%]. The rate of multidrug-resistant bacteria was of 9,5%. The empiric antibiotic therapy used [fusidic acid +amoxicillin/ clavulanic acid] was inactiveon 44,1% of the isolated bacteria. When we compared the group of patients with unfavourable development [who have been reoperated] and the group of patients with favourable development, we have found two poor prognosis factors: arteritis [p=0,018 ; OR=23,7] and presence of multidrug-resistant bacteria [p=0,027 ; OR=5,8]

Conclusion: The enterobacteria were the main bacteria causing the infection of diabetic foot. The prognostic factors found, arteritis and isolation of multidrug-resistant bacteria, outpoint the importance of multidisciplinary care

[Comparison of differents molecular methods for detection dna of human cytomegalovirus infection for immunodepressed]

A Cytomegalovirus infection [HCMV] causes severe complications in immunosuppressed individuals [transplant recipients and AIDS patients]. To detect the DNA of the HCMV by three molecular methods, and to identify the fastest method and most significant. we tested 50 samples in order to detect the presence of the HCMV. This research was carried out by molecular Hybridization, the pp65 Antigenemia and PCR on the blood of the patients presenting an infection to CMV. Molecular hybridization is positive for 64%, Antigenemia is detected in 26 cases [50%] and the plasmatic PCR is positive in 13 cases [26%]. These studies demonstrated that molecular hybridization permitted CMV detection of different biological liquid but Antigenemia and PCR techniques were used to determine of from leukocytes. Plasma-PCR and Hybridization assay presented the qualitatifs results. These studies indicate that there is a combining virological between molecular methods

[Diagnostic and virological follow up of human cytomegalovirus infection]

The Human cytomegalovirus [HCMV] is a ubiquitous herpes virus and is a common virus worldwide. It is important in human pathology and causes serious diseases. Our study is to specify the biological, anatomical and epidemiological aspects, as well as the circumstance of the diagnostics and the principal treatments of infections with HCMV. The descriptive study covered all articles published in with the key words Cytomegalovirus, Immunocompromised patients, bone-marrow transplants, renal transplants, AIDS patients, PCR, pp65 antigenemia We found 200 articles published in international reviews. That has been eligible to the study. Most of these articles were concerned about experimental and clinical work [67%and 21%respectively]. The majority [80%] of the articles is written in English. The human cytomegalovirus is the origin of serious infections in patients having an immunity deficit. The study of the place of the HCMV in immunocompromised, is thus of an indisputable interest to understand the factors associated with this infection

Evaluating the therapeutic care of HIV infection in Tunisia

Our aim is to determine different therapeutic response profiles in Tunisian HIV- 1 infected patients, to identify those with therapeutic failure and to compare the results of the genotypic resistance test used in Tunisia [INNO LiPA Test] with those of automatic sequencing to evaluate its efficacy. The retrospective survey concerns 392 infected patients enrolled from January 2001 to December 2006. Evaluation of HIV INNO LiPA test was performed by comparing these test results with those of automatic sequencing in 36 plasmatic samples for 13 infected patients with therapeutic failure. on the basis of the HIV viral load evolution, 57.55% of patients present a good therapeutic response and 42.44% a bad one. Patients with therapeutic failure require genotypic resistance test. A comparison of HIV INNO LiPA test and direct sequencing showed a strong concordance between the two tests results either for reverse transcriptase gene or protease gene. However, the uninterruptible results obtained by INNO LiPA test [8.79% of analysed codons] and the limited number of analysed codons were the defaults of INNO LiPA technique .the contribution of INNO LiPA technique in the knowledge of the epidemiological HIV resistance profiles of virus strains of HIV infected individuals failing therapy was considerable. However, due to INNO LiPA technique limitations, sequence analysis must be considered a more complete assay for the monitoring of antiretroviral resistance of HIV infected patients

[Virological diagnosis and follow-up of HIV infection]

Human immunodeficiency virus [HIV] is a retrovirus infecting approximatively 40 millions people worldwide. HIV is characterized by a great variability with epidemiological, diagnostic and therapeutic implication. This course of infection goes through three stages [acute infection, clinical latency and AIDS] with the evolution of virological markers [anti-HIV antibodies, p24 antigenemia, plasma RNA and prevail DNA]. Direct virological diagnosis is mainly based on molecular tools allowing viral genome detection and amplification with specific primary and nucleic probes, besides p24 antigenic detection, and more rarely culture. Antigenic properties of viral proteins elicit in infected patients antibody synthesis, which is detected using serology [ELISA and Western blot tests]. The follow-up of infected patients is carried out with plasma HIV-1 RNA quantization and phenotypic or genotypic characterization of variant isolated. Virological testes are prescribed according of clinical presentation [screening, acute infection, newborn from HUIV-infected mother]. Most of these virological tools are available in Tunisia, allowing both diagnosis of HIV infection and monitoring of infected individuals. Regarding diagnostic tests indication and interpretation, multidisciplinary concentration is hopeful in order to optimize patient management

[Detection of DNA human cytomegalovirus of a molecular methods: hybrid capture DNA CMV by immunocompromised]

Human cytomegalovirus [HCMV], a member of the beta-virus herpes family, is a ubiquitous human pathogen. After a primary infection, HCMV establishes life latency. HCMV rarely causes symptomatic disease in an immunocompetent host, however, it is a major cause of infectious morbidity and mortality in immunocompromised individuals and developing fetuses. The HCMV genome consists of 240 kbp of double stranded DNA. Early diagnosis molecular of CMV infection is important. The objective of this study was to develop a molecular methods: Quantitative Hybrid capture for the detection of DNA CMV. We present results for 200 immunocompromised collected from 1999 to 2003 [122 men and 78 women, whom mean age was 35 years]. Our results showed that 25% of women and 36% of men were positif for hybrid capture DNA CMV.This simple test [cold probe] provide quantitative and fast results. Also the efficacity of anti-CMV therapy can be followed. More over. in contrary with pp65- antigenemia assay and CMV PCR, this test can be managed on biopsy sample

Evaluation of HPV oncogen risk in condyloma. A prospective study of 24 patients

Human papillomavirus [HPV] infection tend to be the most prevalent sexually transmitted disease [STD], and "high-risk" HPV types are correlated to intro-epithelial neoplasia, especially cervical cancer. - The aim of this study was to evaluate the frequency of "high-risk" HPV types in condylona. - Patients and methods: a non randomized prospective study was performed, including 24 patients with condyloma examined int the department of Dermatology of Charles Nicolle's hospital. Molecular hybridization method was realized for all patients to identify HPV type. - - Mean age of the 24 patients was 37.8 years. - Ratio [male/female]: 1.4 - In 21 patients HPV DNA was detected. - 2 women had "high risk" HPV type [9.5 percent]