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

Unbalanced bone remodeling in Tunisian patients with inflammatory bowel diseases

Bone loss is an ignored complication in inflammatory bowel diseases. Its underling mechanisms are not fully elucidated. To investigate bone turnover in patients with inflammatory bowel diseases.The study included 67 patients with inflammatory bowel diseases and 54 age- and sex-matched healthy subjects. Urinary degradation products of C-terminal telopeptide of type I collagen, serum osteocalcin, parathyroid hormone, 25 hydroxy vitamin D and interleukin-6 were assessed. Bone mineral density was measured by dual energy-X-ray absorptiometry and osteoporosis was defined as T score < -2.5 SD. Patients showed significantly higher levels of C-terminal telopeptide of type I collagen and interleukin-6 and lower levels of 25 hydroxy vitamin D. Serum osteocalcin and parathyroid hormone were in normal range. In multivariate analysis, urinary degradation products of C-terminal telopeptide of type I collagen were associated with disease activity [p=0.04] and osteocalcin was associated with parathyroid hormone [p=0.04]. Urinary degradation products of Cterminal telopeptide of type I collagen and interleukin-6 were significantly increased in inflammatory bowel disease patients with osteoporosis. No association was found between osteoporosis and serum osteocalcin, parathyroid hormone and 25 hydroxy vitamin D. Bone resorption rate is increased and is associated with osteoporosis in inflammatory bowel disease patients. Inflammation, malnutrition, and hypovitaminosis D may contribute to the bone loss

Aminoacidopathies and organic acidurias in Tunisia: a retrospective survey over 23 years

Inborn errors of metabolism are neglected in developing countries because they are not as common as infectious and nutritional disorders. In Tunisia, no information is available on the incidence and epidemiological features of these inherited metabolic diseases. To precise the profile of aminoacidopathies other than phenylketonuria and organic acidurias and to estimate their incidences in Tunisia. Between 1987 and 2009, our laboratory received 13171 requests for analysis of patients with symptoms suggestive of inborn errors of metabolism. For these cases, ion exchange chromatography of free amino acids was performed on amino acids analyser. Urinary organic acids profiles were determined by gas chromatography-mass spectrometry. Abnormal cases were 370 [2.8%], divided into 212 cases of aminoacidopathies [57.3%] and 158 cases of organic acidurias [42.7%]. The most frequent aminoacidopathies, were maple syrup disease [32.5%], tyrosinemia type I [28.8%] and nonketotic hyperglycinemia [16%]. Methylmalonic aciduria [33.5%], propionic aciduria [18.4%] and 2-hyrdoxy glutaric aciduria [10.8%] were the most frequent organic acidurias. The incidences were calculated using the Hardy-Weinberg formula and were estimated at 1/13716 for maple syrup disease, 1/14804 for tyrosinemia type I, 1/16144 for methylmalonic aciduria and 1/23176 for propionic aciduria. Aminoacidopathies and organic acidurias turned out to be highly frequent in Tunisia, mainly because of a high rate of consanguinity. We believe that they are underestimated. To improve their diagnosis, it is necessary to have available sophisticated equipment which would allow early treatment of patients

[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

Intracranial abscess and empyema from ENT origin

Intracranial abscess and empyemas from ENT infection are rare. The aim of our study was to recall the treatment and therapeutic results. It was a retrospective study from 1995 to 2006 concerning. 23 patients who had brain abscesses secondary to an ENT infection. The infections origin was otological in 56% of cases, sinusal in 44%. Bacterias were identified in 40% of cases. All patients benefited a medical treatment to basis of at least 2 antibiotics a long length going from 20 days to 3 less by intravenous way. Nine patients benefited neurosurgery with an ENT treatment surgical. Nine patients had alone neurosurgery and 5 cases had an ENT surgery alone. The treatment consists in excision or single punction of the abscess. 72% are alive and well. We have no dead. The classical intracranial hypertension associated to high fever is usually truncated. The diagnosis is more precocious thanks to the progress of the medical imagery. Multibacterial infections are frequent. Treatment is medical and surgical. Recovery requires a specific surgical treatment of the ENT infection in more than 60% of cases. An adapted treatment permits a recovery without after effects in at least the half of cases

[Unusual thyroid lesion]

The incidence of aspergillosis has increased during the past decade with the widespread use of aggressive chemotherapy and immunosuppressive agents. The lungs are the most common primary site of infection. Thyroid involvement is rare, usually asymptomatic, and difficult to make an ante-mortem diagnosis. Our aim is to discuss the epidemiological characteristics, the diagnosis and the histogenesis of this unusual thyroid lesion. Case report A 13-year-old girl, with a past history of lung disease was hospitalised for cervical pseudo-tumoral lesion. Cervical scintigraphy was taken and showed abnormal uptake in the thyroid. A resected specimen of the thyroid showed an extensive abscess with diffuse aspergillus hyphae infiltration. Treatment with amphotericine B was initiated and the evolution was unfavorable. Aspergillus infection frequently disseminates to a variety of organs, thyroid involvement is rare and its prognosis depends on early diagnosis and prompt initiation of therapeutic measures

[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

[Hypopharyngeal Zenker's diverticulum about four cases]

The hypopharyngeal Zenker's diverticulum is a rare pathology [1%of oesophagien pathology]. It is up to a hernia of the oesophagus posterior wall throught the fibres of the pharynx inferior constrictor muscle. Many pathogenic hypotheses are put forword; it is generally benign but can cause serious complications. The treatment can be difficult. The best treatment seems to be diverticulectomy with cricopharyngeal myotomy. Endoscopic treatment can be a good therapeutic alternative. We report four cases of patients with DPO three women and one man; the mean age of patients was 67 years. All our patients suffered from dysphagia and loss of weight. The diagnostic, clinically suspected was cofirmed by radiological examinations. All our patients were operated. Surgery was satisfactory for three patients. One patient died

Thyroid primitive lymphoma on Hashimoto thyroiditis: about a case

Lymphoma is a rare form of malignant thyroid tumor. It often develops on concomitant or pre-existing thyroid disease. We present a case of thyroid lymphoma that developed on a Hashimoto thyroiditis and we review the clinical characteristics of the evolution of this disease as well as the controversy surrounding its management. Our patient was a 44 year old female that had surgery in our department because of a rapidly growing thyroid nodule associated with symptoms of cervical compression. Total thyroidectomy was performed. The pathology report concluded that it was a B cell lymphoma associated with Hashimoto thyroiditis. The treatment was completed by chemotherapy but the local evolution could not be stopped