[Upper urinary tract infections in adults: about 261 episodes]

Upper urinary tract infections are frequent. Escherichia coli is the main pathogen identified from community acquired infections. We aim to study epidemiologic, clinical and bacterial features of this infection. We identified 261 episodes that occurred in241 patients. They were 213 females and 48 males aged of 48, 75 years. Enterobacteriaceae were the main pathogens isolated in 93,5%: E. coli in 73,3% and Klebsiella pneumoniae in 15,3%. E.coli sensitivity was of 30% for amoxicillin, 98% for cefotaxim, 96% for gentamicin, 90% for ciprofloxaine and 56% for co-trimoxazole. Anterior antibiotic use was associated with low E. coli sensitivity mainly with fluoroquinolones [96 vs 77%] and co-trimoxazole [62 vs 43%]. This enhances the role of antibiotic pressure on the resistance emergence. The reasonable use of antibiotics is necessary to limit resistance extent

[Mucormycosis: four case reports]

Mucormycosis is a rare and invasive fungal infection, but frequently fatal when it occurs. It commonly affects patients with diabetes mellitus. The aim of this study is to assess the clinical presentation, radiological findings, management and prognosis of mucormycosis. This retrospective study was conducted in the department of infectious diseases of Rabta hospital between January 1988 and December 2004 and included patients hospitalized for mucormycosis confirmed by mycological and/or histological findings. The study is about four diabetic patients with mucormycosis [3 men and a woman]. Three of them had diabetic ketoacidosis at the time of diagnosis. The infection was sinusal in 2 cases and rhinocerebral in the other two cases. Treatment consisted in systemic amphotericin B combined with surgical debridement in 3 cases. A fatal outcome was noted in 2 cases. Mucormycosis remains a severe infectious disease in diabetic patients. Early diagnosis and treatment is mandatory for a successful management of this infection

Aids-associated kaposi's sarcoma: 22 cases

Kaposi's sarcoma is the most common acquired immune deficiency syndrome [AIDS]-associated malignancy. Our aim was to analyse the epidemiological, clinical, therapeutic findings in AIDS patients with Kaposi's sarcoma. This was a retrospective chart review of AIDS patients with Kaposi's sarcoma diagnosed between 1991 and 2005. Epidemiological data, the stage of human immunodeficiency virus's [HIV] infection, clinical characteristics of Kaposi's sarcoma, treatment rendered and outcome were collected. The search of HHV8 was not done. Twenty two patients were included. They were 17 men and 5 females [sex-ratio=3.4/ 1] with a mean age of 33.6 years at the diagnosis of HIV infection. The Kaposi's sarcoma appeared after a period varying between 0 and 10 years. The Kaposi's sarcoma uncovered the infection in 5 cases. There were 6 homosexual men. The mean rate of CD4 was 216 21/mm3 at the diagnosis of Kaposi's sarcoma. All patients had skin lesions. Mucocutaneous lesions were isolated in 12 cases and associated with visceral involvement in 10 cases; lung [10 cases], gastrointestinal tract [5 cases], lymphadenopathy [5 cases], liver [4 cases], spleen [2 cases]. Antiretroviral therapy was prescribed for 13 patients. Six patients received chemotherapy and 3 others radiotherapy. Outcome was favourable in 4 cases with a partial improvement of the skin lesions in 3 cases and a complete regression in 1 case. Twelve patients died. AIDS associated Kaposi's sarcoma is a severe condition because of visceral localisations and the field of immunodeficiency. It requires a precocious diagnosis and collaboration. The identification of HHV8 in the aetiopathogenic mechanism of Kaposi's sarcoma can lead to the development new therapeutic approaches

[Brain abscess in medical environment, a current problem]

Brain abscesses are severe infections with lethal outcome in the case of delay in diagnosis and treatment. The authors report their experience about 30 patients with pyogenic brain abscesses treated between 1989 and 2000. The goal of the study is to analyse epidemiological, clinical and therapeutic aspects of this disease. The sex ratio [M:W] was 2,3 and the mean age was 34 years. Predisposing factors were sepsis of adjacent organs [53%] and bacteremia [30%]. The clinical manifestations were: fever [83%], headaches [90%] and focal neurologic signs [57%]. CT-scan findings were single lesions in 80% of cases. CT-scan showed a deep ring-enhancing lesion with surrounding edema in 77% of cases. Bacteriological agents in 13 cases [43%] were: 4 Staphylococcus aureus, 2 Neisseria meningitidis and 7 negative Gram bacilli. Medical treatment alone was in 77% of cases seven patients benefited from medical and neurosurgical approaches. Death occurred in 10% of cases