[Hereditary complement C5 deficiency: study of 3 Tunisian adult cases and litterature review]

The complement system is one of the main effectors of both innate and adaptive immunity. Hereditary complement deficiency, mainly those of the terminal pathway [C5-C9], is at increased risk for septic meningitides particularly meningococcal ones. To assess clinical and biochemical features of 3 Tunisian adults with C5 hereditary complement deficiency [C5D], with a familial study performed for two of them. Functional activity of the classical and the alternative pathway of complement [CH50 and AP50 respectively] were measured according to standards haemolytic procedures. Serum concentration of complement components were determined by nephelemetry and ELISA. C5D was diagnosed when CH50, AP50 and C5 antigenic level were highly decreased. Our patients were 2 men and one woman. All these patients presented clinical symptoms of septic meningitides. Meningococcal origin was confirmed in one case. C5 level varies between 0 and 0,4%. Levels of other complement components: Clq, C3, C4, properdine, C6, C8 and C9 were normal. Antigenic C7 level was 50% in the female patient. Familial study revealed no similar hereditary complement deficiency in relatives. Only 27 cases with C5D were reported in the literature. The description of 3 cases in our series demonstrates that: C5D is not rare in Tunisia, C5D is clinically commonly complicated by meningitides with unconstant severity, C5D is biologically caracterised by a variable level of the plasmatic C5 component

[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