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

[Adverse reactions to antibiotics: a retrospective study of three years in the regional pharmacovigilance center of Sfax]

Adverse reactions to antibiotics constitute a real public health problem. In this work, the frequency, types, predisposing factors and severity of adverse reactions to antibiotics have been analysed. Our retrospective study gathers all adverse reactions to antibiotics produced by spontaneous reporting to the regional pharmacovigilance center in Sfax in the south of Tunisia, for a period of three years. Among 249 cases of drug adverse effects, 82 [32.93%] were related to antibiotics. The age ranged from 5 to 86 years. There were 55 women and 27 men. Seventy [85.36%] adverse reactions to antibiotics among 82 were immune-allergic. In 60 cases [73.17%] patients had medical history of atopy, drug allergy, autoimmunie diseases or chronic conditions requiring poly-medication. 54 patients [65.85%] were taking 3 or more medications. Severe forms have been observed in 12 patients among 82 [14.63%]. Poly-therapy, chronic illness and advanced age are factors favouring the occurrence of adverse reactions to antibiotics. Our results have highlighted the increased risk in patients with a history of allergy to an antibiotic to develop an allergy to another antibiotic

[Acute cholestatic hepatitis induced by amoxycillin-clavulanic acid combination]

Cholestatic hepatitis associated with amoxicillin-clavulanic acid is probably underestimated. The time interval between stopping treatment and the first manifestations may hinder diagnosis. We report a case of cholestatic hepatitis induced by the association amoxicillin-calvulanic acid. A 15-year-old man without significant past medical history received a six-day-course of amoxicillin-calvulanic acid for acute bronchitis. Nine days after completing his treatment, he developed a jaunadice with fever. The biological tests showed conjugated bilirubin of 23 mg/dl without hepatic cytolysis. Extrahepatic obstruction and viral causes were excluded. The clinical symptoms resolved within ten days. The mechanism of amoxicillin-clavulanic- acid- induced hepatitis is probably immunoallergic. Clavulanic acid component of the combination is most likely the cause of hepatitis. Symptoms may appear even a few weeks after stopping the drug. So practitioners should think about this risk, if such symptoms appear even after stopping the drug