[Hereditary complement C5 deficiency: study of 3 Tunisian adult cases and litterature review]

The complement system is one of the main effectors of both innate and adaptive immunity. Hereditary complement deficiency, mainly those of the terminal pathway [C5-C9], is at increased risk for septic meningitides particularly meningococcal ones. To assess clinical and biochemical features of 3 Tunisian adults with C5 hereditary complement deficiency [C5D], with a familial study performed for two of them. Functional activity of the classical and the alternative pathway of complement [CH50 and AP50 respectively] were measured according to standards haemolytic procedures. Serum concentration of complement components were determined by nephelemetry and ELISA. C5D was diagnosed when CH50, AP50 and C5 antigenic level were highly decreased. Our patients were 2 men and one woman. All these patients presented clinical symptoms of septic meningitides. Meningococcal origin was confirmed in one case. C5 level varies between 0 and 0,4%. Levels of other complement components: Clq, C3, C4, properdine, C6, C8 and C9 were normal. Antigenic C7 level was 50% in the female patient. Familial study revealed no similar hereditary complement deficiency in relatives. Only 27 cases with C5D were reported in the literature. The description of 3 cases in our series demonstrates that: C5D is not rare in Tunisia, C5D is clinically commonly complicated by meningitides with unconstant severity, C5D is biologically caracterised by a variable level of the plasmatic C5 component

Epidemiologie des septicemies a bacilles gram negatif: donnees d'un hopital Tunisien [1996 - 1998]

Gram negative bacilli [GNB] septicemia are among the most serious infections encountered in the hospital since they generally occur on debilitated patients and are due to the multi-drug resistant bacteria. A retrospective study relating to 195 septicemia was carried out with an aim studying epidemiologic profile, predisposing factors, entry sites for micro-organisms, responsible GNB and their antibiotic susceptibility. GNB septicemia were mainly frequent in intensive care units [34%] and surgery [31%]. Previous antibiotherapy, invasive procedures and surgical acts were the principal predisposing factors. The entry sites for micro-organisms remained unknown in 1/3 of the cases. The most common source of septicemia was the urinary tract infections. E. coli was the most frequent isolated bacteria [26%] in the community acquired spticemia whereas klebsiella enterobacter serratia [KES], acinetobacter and pseudomonas were mainly encountred in nosocomial infections. Imipenem remained the most active betalactamin on GNB [2% of resistance] with amikacin [16% of resistance] among aminoglycosides. The rate of mortality was 18%. Hospitalization wards [intensive care units, surgery], entry sites unknown, septic shock syndrome were the main factors of prognosis. The development of immunology and molecular biology should improve the outcome of these infection but the preventive measures remain the most effective