[Antimicrobial susceptibilities of emterobacteriaceae isolated from urinary tract infections in the area of Monastir]

The aim of this study is to determinate the local epidemiology of urinary tract infections in the university hospital of Monastir and to evaluate antimicrobial susceptibility of most incriminated Enterobacteriaceae strains since 2002 to 2005. Identification of strains was based on conventional bacteriological features. Susceptibility to antibiotics was studied according to the Antibiogram Committee of the French Microbiology Society recommendations. In total, 8505 Enterobacteriaceae strains were isolated including Escherichia coli [76%] followed by Klebsiella spp. [10.5%] and Proteus mirabilis [4%]. For E. coli and P. mirabilis, resistances rates were respectively 61% and 71% to amoxicillin, 46.4% and 45.5% to the combination amoxicillin-clavulanic acid, and 39.6% and 26% to cotrimoxazole. Strains of Klebsiella spp. were resistant to cefotaxim and amoxicillin + clavulanic acid in respectively 42% and 20% of cases. Finally, from 2002 to 2005, a significant increase in Enterobacteriaceae resistance was observed for ofloxacin, from 11.9% to 17.6% and ciprofloxacin, from 9.1% to 14.5%. The emergence of antimicrobial resistance justifies that empiric treatment of urinary tract infections should be revised regularly

[Cerebral toxoplasmosis during AIDS in Tunisia: epidemic logical, clinical and therapeutic aspects]

Cerebral toxoplasmosis [CT] is a severe parasitic disease during HIV infection. It is the most frequent opportunistic infection of central nervous system in AIDS. To study epidemiological and clinical data, and to discuss therapeutic strategy during this disease. This is a multicenter retrospective study from the Tunisian departments of infectious diseases. All medical charts of patients admitted for CT from 1st January 1985 to 31[th] December 2004 were reviewed in order to investigate epidemiologic, clinical and therapeutic data. During the study period,78 cases were collected with an incidence of 9.75%. There were 65 men [83.3%] and 13 women [16.7%], with mean age of 34.5 years [range: 18-52 years]. CT was the first AIDS-defining illness in 30 patients [38.5%]. Heterosexuality was the main risk factor for HIV infection [41%]. Headache, fever and neurologic disorders were the main clinical signs. Toxoplasmic antibodies [IgG] were found in 88.4%. Median CD4 cell count was at 33/mm[3]. Diagnosis of CT was based on neuro-imaging data [CT-scan and/or magnetic resonance imaging] wich shows multiple lesions [59%] associated to cerebral oedema. Pyrimethamine-sulfadiazine or pyrimethamine-clindamycine were the 2 main regimen for treatment, associated in some cases to steroids. Improvement was observed in 50% of cases. Thirty three patients [42.3%] died during the first episode of CT. The severity of CT in AIDS requires early diagnosis and treatment to improve prognosis. Early detection of HIV infection and improvement of immunologic status of patients under antiretroviral treatment are necessary to decrease incidence of this opportunistic infection

[Breast tuberculosis: study of 15 cases]

Mammary tuberculosis is a rare disease especially seen in underdeveloped countries. Describe the epidemiological, clinical parameters of mastitis tuberculosis and determinate the interest of imagery and histology in diagnosis. Fifteen cases of tuberculous mastitis diagnosed at the Infectious Diseases and Gynaecology departments of F. Bourguiba hospital during the period from January 1988 to March 2006. The mean age of our patients was 29.2 years [21 - 56 years]. History of tuberculosis was found in 33.3% of the cases. Sixty percent presented with fever and 73.4% complained of skin abscess. We noted symptoms of tuberculosis impregnation in 53.3% of cases. The fine needle aspiration achieved for all patients was negative in 14 cases and brought back the caesium in the other. The diagnosis has been made, for all our patients, after histological study when we found typical tuberculosis lesions on pieces of tumorectomy or biopsy. All patients had an anti-tuberculosis medical treatment. The median duration of treatment was 10 months [9 -18 months]. Although tuberculosis of breast is extremely rare, it should be kept in mind particularly in undeveloped countries. In front of symptoms evoking tuberculosis, biopsies must be done to eliminate an eventual cancer

[Drug rash with eosinophilia and systemic cymptoms [DRESS syndrome] associated with sulfasalazine and human herpesvirus 6 infection successfully treated with steroid therapy]

We report a case of a 30-year-old man who developed a generalized erythematous skin eruption, fever, lymphadenopathy, hepatic cytolysis and eosinophilia probably due to sulfasalazine. Indirect immunofluorescence assay for Human herpesvirus-6 [HHV-6] was positive, supporting recent HHV-6 infection. The patient was successfully treated with dexamethasone. The case is reported with a review of the literature. DRESS syndrome mechanisms and management are also discussed

Aspects epidemio-cliniques et therapeutiques de la brucellose en Tunisie A propos de l'epidemie de Gafsa

This prospective study was carried out, in south Tunisia, to evaluate epidemiological, clinical, therapeutical aspects of brucellosis and elaborate a preventive strategy. Three hundred niniteen patients with brucellosis, notified in Gafsa district, were reviewed from January 1th, 1992 to December 31st, 1992. Serological confirmation was obtained in all cases. One hundred ninety three men [60,5%] and 126 women [39,5%] were studied. Mean age was of 39,4 [range: 3-85] years. The majority of these patients [74,3%] lived in rural districts. Consumption of unpasteurized milk [93,4%], contact with domestic animals [84%] and professional exposition[35,7%] were the main modes of contamination. The high frequency of family cases is noteworthy and emphasize the insufficiency of sanitary measures and the herds promiscuits in rural districts. We demonstrated that the combination of oxytetracyclin, 35 mg/kg/day, for 6 weeks and rifampin, 20 mg/kg/day, for 3 weeks is an effective treatment. The relapse rate was 3,7%, if we excluded reinfection cases by persistent exposition. This epidemic, secondary to insuffiscent preventive measures and importation of infected animals from a bordering country, emphasized the relationship between animal and human disease and take an enterst in a better breeding organisation. The positive results of our preventive action demonstrated the importance of sanitary measures. Rigourous application of other recommendations is necessary to sea a regression of the disease

Brucellosis epidemiology, clinical and therapeutic

A retrospective survey, over a 18 years period [1971-1989] at the Infectious Diseases Unit- La Rabta, yielded 47 cases of brucellosis. Brucellosis is common in men, after a professional exposure [27%] or consummation of milk and by-products non fermented [36%]. The clinical picture of the disease was a fever of less than 3 weeks duration [71%] associated to sweat and pain. Focalised forms are seldom and there were no chronic form. Brucella melitensis was isolated from blood in 23%. The efficacy of antibitherapy [cyclin associated to rifampicin] was excellent. The prognosis was good with recovery in all cases even in one case of relapse under cyclin

Pour une meilleure utilisation des antibiotiques

The author analyse the different factors of the bad use of antibiotics and propose some recommandations in order to remedy