Visceral leishmaniasis in north african countries

Leishmaniasis are worldwide vector-borne diseases due to protozoan flagellates of the genus Leishmania [L.], transmitted by Phlebotomine sandflies to human and mammalians. These affections are endemic in tropical and temperate-climate regions where over 350 millions of people are at risk. The clinical spectrum of leishmaniasis is wide, including asymptomatic infection and 3 main clinical forms: visceral leishmaniasis [VL], potentially fatal when untreated; cutaneous leishmaniasis, usually benign; and mucosal leishmaniasis, a conversely severe mutilating disease[2,3]. Visceral leishmaniasis is caused by L, donovani complex, including L. donovani in the Indian subcontinent and Eastern Africa, and L. infantum in the Mediterranean area, Middle East and Latin America[2,4]. These species are able to spread to internal organs, primarily the liver then the spleen, the bone marrow and the lymph nodes[2,3]. Over 90% of VL cases ensue in the Indian subcontinent and East Africa, and are due to L. donovani with the predominant anthroponotic way of transmission[2]. In the Mediterranean basin, as well in the Middle East, China and South America, VL is caused by the zoonotic species L. infantum[5,6] In North African [NA] countries, VL has been described since the beginning of the 20[th] century. The first case was described in 1904 by Laveran and Cathoire in a child from La Goulette, Tunisia[4]. Since the eighties, there is a clear tendency towards increase with a large-scale spread of emerging cases as observed in several areas of the world[7,9]. Currently, VL is emergent and represents a significant health problem in Algeria, Morocco and Tunisia because of the case-fatality rate, estimated between 5 and 8% [even in treated patients], and regarding the economic burden concerning the cost of treatment and hospitalization[10]. In the present review, the authors updated the epidemiological situation of VL in Morroco, Algeria, Tunisia, Lybia and Egypt. Clinical presentation of the disease and the current strategy for diagnosis and treatment were summarized and discussed

[Primitive acute polyradiculo-nevritis in child: the Kairouan pediatric department experience. about 22 cases]

Guillain-Barre Syndrome [GBS] is an acute polyradidulonevritis which is primitive inflammatory and demyelinisant. It represents the most frequent cause of acute peripheric paralysis of the child. To study the epidemiologic, clinic, electromyographic, outcome and therapeutic features of this disease. 22 cases of GBS were reported in the pediatric department of Ibn El Jazzar's hospital of Kairouan from January 1990 to September 2009. The GBS represents a hospital frequency of 0.45%o. The mean age of the patients was 6.88 years with a sex ratio of 1.2. The prodromic infectious manifestations were observed in 54.5% of cases. The clinic symptomatology was the muscular deficiency observed in all cases with absence of deep reflex an albumincytologic dissociation was observed in 12 cases. The electromyographic manifestations were: an axonal disorder in four cases, axonomyelinic in eight cases and myelinic in seven cases. A specific therapy by intravenous polyvalent immunoglobulin was prescribed for 14 patients. The evolution was favourable in 10 cases with total recovery three cases of drop foot gait were observed, seven patients were lost to follow up and two patients are dead. GB syndrome is the most frequent cause of child acute primitive distal paralysis, since acute polio has been eradicated. Acute Respiratory disorder is the most severe complication this syndrome can lead to in 5% of cases. The course of the disease is often mild and severe scars are only encountered in 5 to 10% of cases. Indeed, the use intravenous immunoglobulin has utterly changed prognosis