Brucellar spinal epidural abscesses. single center experience of nineteen patients and review of the literature

Brucellar spinal epidural abscesses [SEA] are rare and very few series of them have been reported. We aimed to evaluate the clinical characteristics, laboratory, radiological findings and outcome of this entity. Of 146 patients with brucellosis, 19[13%] patients were diagnosed to have SEA during a period of 21 years [1990-2010]. Diagnosis made on clinical presentation, laboratory findings, radiographic evidence and the brucellar etiology was considered when seroagglutination tests were positive at a titer of 1/160 or higher, and/or Brucella spp. were isolated in the blood. The mean age of patients was 51 +/- 16 years [14 males, 5 females; age range, 22-74 years]. The median diagnostic delay was 2 months. Back or neck pain [100% of patients], fever [100%], and sweating [68.6%] were the most common symptoms. Cultures of blood specimens from 4 patients [21%] were positive for Brucella melitensis. Three patients [15.8%] had motor weakness or paralysis. Magnetic resonance imaging was performed in all cases. The lumbar vertebra was the most frequently involved region with the rate of 84.2%, followed by thoracal [15.8%], cervical [5.3%], lumbosacral [5.3%], and thoraco-lumbar [5.3%] segments. A combination of rifampin and doxycycline was the most widely used therapy regimen [9 cases, 47.3%]. The duration of antimicrobial therapy of brucellosis [median, 7 months; range, 4-13 months] varied according to the clinical response. There were no deaths or severe sequelae in this study Brucellar SEA should be considered in patients who have back pain and neurologic disorders as well as systemic symptoms and findings in or from endemic areas

[Characteristics of invasive group B streptococcal infections in adults]

An obvious increase in the invasive due to group B streptocoque [GBS] in adult has recently been noted in several developed countries. Very few series describe the situation in developing countries. To determine the epidemiologic characteristics, the clinical features, the underlying conditions and the course of these infections observed in a Tunisian hospital. We retrospectively analysed 65 episodes hospitalized between 1993 and 2007. The sex-ratio was 0.3 and the mean age was 59 years. 73.8% of the patients had at least one risk factor. These factors were dominated by diabetes mellitus [40%] and recurrent urinary tract infections [25%]. Urosepsis, genital infections and bacteremia with no identified focus dominated the clinical manifestations. 13.9% of these infections were poly-microbial and all GBS isolates were sensitive to penicillin. The course was often favourable, 4.6% of the patients died and a recurrence of the invasive infection was noted in 7.7% of the cases. Our study shows a particular clinical spectrum of invasive group B Streptococcal infections in adults and confirms the role of underlying medical conditions. A Tunisian multi-centric study would specify the actual extent of these infections in our country

[Characteristics of emphysematous pyelonephritis: about four observations]

Emphysematous pyelonephritis is a severe infection which necessitates a management that is both medical and surgical. Early systematic antibiotic therapy is required. Percutaneous drainage is now the first urological approach in most cases. It should not however delay, if necessary, an eventual nephrectomy. We report our experience during 15 years in four women