High risk areas for echinococcosis-hydatidosis in Tunisia

The study was conducted in order to identify high risk areas for hydatidosis in Tunisia witch would be eligible for a Hydatidosis control program initiation. The most recent epidemiological investigation on surgical incidence of hydatidosis was used to classify governorates according to their incidence rate. A [global hydatidosis risk score] was calculated for each governorate, combining some parameters related to the hygiene conditions of the population, the literacy rate, the canine density and livestock census. Spearman correlation coefficient was used to compare scores and surgical incidences. Mapping analysis has been conducted. The surgical incidence rate of hydatidosis classifies each governorate regarding occurrence of human cases. The global hydatidosis risk score, by governorate, pointed out the most exposed areas to the disease. The mapping analysis showed a good agreement between the incidence rate of the disease and the global hydatidosis risk score and made it possible to identify the population of the center and the west of the country as a most exposed population for the diseases. In order to have a chance for implementation, hydatidosis control program should target the three jointed governorates of Kasserine, Siliana and Kef, which have the highest incidence rates and the worst scores

[Epidemiological, clinical and therapeutic features of hepatocellular carcinoma in cirrhotic patients]

Hepatocellular carcinoma [HCC] is the most frequent primitive hepatic tumor, the fifth most common cancer in the world, and the third highest cause of cancer-related mortality. The presence of cirrhosis is the main risk factor. To describe the epidemiological, clinical and therapeutic features of HCC. Retrospective study including all the patients with HCC occurring in cirrhotic liver followed in the gastroenterological department of Charles Nicolle hospital between 1997 and 2009. A hundred and one patient were enrolled; 64 men and 37 women with a median age of 65.4 years [31-88 years]. Cirrhosis was due to viral hepatitis B or C in 25.7% and 62.2% of cases respectively and was classified Child Pugh A, B and C in 30.7%, 50.5% and 18.8% of patients respectively. HCC was inaugural in most cases [68.3%] and it was revealed by a tumoral syndrome in 38.6% of cases, by decompensation in 22.7% and was discovered during systematic screening when cirrhosis was already known in 19.8% of cases. Diagnosis of HCC was non invasive, relying imaging and alphafetoprotein in most cases [95%].84 patients [83.2%] had and advanced HCC, with vascular or extra hepatic spread in 58 [57.5%] of them. Treatment was curative in 14 cases, based on surgical resection in one and percutaneous ablation in 13 cases. Six patients received transarterial chemoembolization as a palliative treatment. In 71 patients, only symptomatic treatment was given. The median survival time was 11 months. In the majority of the cases, HCC was diagnosed at an advanced stage and treatment was only symptomatic

Difficulty in dating primary infections by Toxoplasma Gondii in pregnant women in Tunisia

In Tunisia, serological diagnosis of toxoplasmosis in pregnant women is generally ordered on the first prenatal consultation. As primary tools, IgG and IgM tests are done. Subsequent serological testing is performed to date infection in case of IgM positivity. IgG avidity measurement was done in 156 sera with IgM. The kit [Toxo Avidite] from SFRI was used. This commercial assay permits to rule out an infection acquired in the last 12 months in case of avidity index [AI]>0.6 and to suspect a recent infection acquired in the last 3 months in case of AI<0.3. 57.1% of pregnant women had an AI>0.6; 17.9% an AI<0.3 and 25% an intermediate AI. The high and middle IgG titles were frequently associated with an AI>0.6 whereas low titles were generally associated with an AI<0.6 [p<0.01] and particularly an IA<0.3. If an AI>0.6 is an indicator against primary infection during pregnancy and an AI<0.3 permits to order amniotic sampling for PCR, intermediate avidity dols not permit to conclude mainly because a great proportion of pregnant women do not lave their first prenatal consultation befoe the second trimester of pregnancy. In these cases search for IgA and follow up samples can be useful. To facilitate serological interpretation, the antibody status of pregnant women should be obtained in Tunisia, before or early in pregnancy.