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

[ rickettsiosis: bacteriological aspects and diagnostic features]

Rickettsiae are gram-negative intracellular rods belonging to the family Rickettsiaceae, which currently includes only two genera: Rickettsia and Orientia. The species within the genus Rickettsia are divided into two groups: the spotted fever group [SFG] and typhus group [TG]. Rickettsiae are usually transmitted by ticks, mites, fleas and lice. After the arthropod bites or penetration through skin excoriations, the epithelial cell is the main target of the bacterium. At the site of inoculation, an eschar will appear, and then the bacteria can reach lymphatic and blood circulation leading to a rickettsemia. The bacteria will then reach several organs including skin rash, lung, brain, heart.. Since Rickettsiae are strict intracellular bacteria, the diagnosis of rickettsial diseases is often confirmed by serology which remains the most accessible tools to the routine laboratory. The microimmunofluorescence is the reference method. For detection and identification of rickettsia, various types of samples can be used such as skin biopsies at the eschar or rash, samples of whole blood or even ticks or fleas. The isolation of these bacteria is restricted to laboratories that can perform cell culture. PCR targeting different genes is sensitive and specific

[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

Salmonella enteritidis spondylodiscitis: case report and review of literature

Extraintestinal manifestions of Salmonellosis are rare. Most of cases reported presented gastrointestinal symptoms, and were immunologically compromised. We report a case of a young immunocompetent patient with Salmonella enteritidis spondylodiscitis. She did not present any digestive symptoms. The tomodensitometric exam revaled L2 L3 spondylodiscitis. The culture of the biopsy yielded S. enteritidis. In the litterature, 115 cases of non-typhoidal salmonellosis were reported. Most of cases occur in patients immunologically compromised by sickle cell disease. Salmonella enteritidis, Salmonella typhimurium and Salmonella choleraesuis were the most common serotypes described

[Prognostic factors of pneumococcal meningitis. Retrospective study of 31 cases]

Our aim was to study the susceptibility of Streptococcus pneumoniae to antibiotics in patients with pneumococcal meningitis and to search for the prognosis factors in those patients. We have studied retrospectively 31 cases of pneumococcal meningitis. Comparisons were performed with univariate analysis. The mean age was 36,7 +/- 20,5 years [ranged: 9 and 78 years]. The sex ratio was 3,4. The susceptibility of Streptococcus pneumoniae to penicillin G was affected in 10 cases [33% of isolated pneumococcus. The MIC to penicillin G was >/= 2 in only one case. The hospital mortality was 26% [8/31]. With univariate analysis, factors associated with death were: age >/= 55 years [Ss p= 0,006, OR: 17.2; IC[95%]: 2.3-134], albuminorachie >/= 7g/l [p= 0,002, OR: 22; IC[95%]: 1,9-251], shock [p= 0,031, OR: 6.7; IC[95%],: 1.05-42] and Glasgow Coma Score [GCS] /= 7g/l shock and Glasgow Coma Score

Evaluation de la consommation des antibiotiques dans un h“pital universitaire Tunisien

Purpose: To estimate the consumption of antibiotics in our hospital and to determine the points at which the recommendations of good practice of antibiotherapy will be targeted. Patients and methods: Our study is a one day prevalence study where antibiotic prescriptions are analyzed by a group of 6 doctors referents in antibiotherapy. During the study day, 443 patients were studied. Means age was 44.2 +/- 23.3 years [range: 1 and 102 years]. 101 infections were diagnosed in 48 patients [10.8%]. 192 patients [43.3%] received antibiotics. Antibiotherapy was curative in 44% of cases. The most prescribed antibiotics were gentamicin [85.2 DDD/1000 patients], metronidazole [79 DDD/1000 patients], and cefotaxime [73.9 DDD/1000 patients]. According to the evaluation group, 30.7% of the antibiotic prescription was considered unjustified. The antibioprophylaxis represents the category most often unjustified [49%]. The molecules in which prescription was frequently considered unjustified are the ciprofloxacin [67%], the amoxicillin-clavulonate [40%] and the cefotaxime [40%]. Our results suggest that an action of good practice should be targeted at the antibioprophylaxis and should concern especially molecules in which prescription was frequently unjustified

Interet et limite de la technique de micro-immunoflorescence dans le diagnostic des infections humaines a Chlamydia

The Chlamydiae are obligate, intracellular bacteria. They are pathogens specific, causing a broad spectrum of infectious diseases. The micro-immunofluorescence test performed against Chlamydial organisms, using the antigens of the three species of Chlamydia [Chlamydia trachomatis, Chlamydia psittaci and Chlamydia pneumoniae], is the reference method to serological diagnosis of chlamydial infections. A sero-prevalency study in Sfax, performed in the laboratory of microbiology-immunology in the university hospital of Sfax, has shown the widespread of anti-Chlamydia antibodies in our region 45.2%: 4.7% antibodies to Chlamydia trachomatis, 0.5% antibodies to Chlamydia psittaci and 40% antibodies to Chlamydia pneumoniae. The applicability of the microimmunofluorescence technique has allowed to detect species-specific antibody and to permit a condiserable economy of regents and biological materials. However, the cross-reactions observed in 5.9% of cases and the difficulty to distinguish between a recent acute infection and past infection for lack of IgM antibody, make the diagnosis of chlamidial infectious by this method hard and hazardous