[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

[ case of pyomyositis tuberculosis]

Pyomyositis is a muscular infection that is frequently due to commonplace bacteria particularly in immunocompetent patients. However, infections with specific germs can arise even without preliminary risk factors. We report the case of a young non-immunosuppressed patient, who has a sub acute painful tumefaction of a thigh without infectious signs. The clinical examination was in favour of thigh collection. The MRI confirmed this hypothesis and showed an associated osteo-arthritis of the knee. The pus microbiological examination was postitive for Mycobacterium tuberculosis. She favourably evolved under antituberculous treatment and surgical drainage of the collection. As tuberculosis is endemic in our country, we should always consider this diagnosis even in young patients without predisposing factors

Pharmacological bases of pyogenic brain abscesses antibiotherapy

The adequate treatment of cerebral abscesses implicates a rapid start-up of an adapted antibiotherapy. Specific properties characterizing cerebral parenchyma, in particular the low level of its local defences and the presence of a blood-brain barrier limiting diffusion of several antibiotics, imply a perfect control of the antibiotherapy bases. Activity on the micro-organisms involved, bactericidal action, easy diffusion through the blood-brain barrier and the wall of the abscess, as well as conservation of a good activity in the pus are the principal criteria of the treatment. The real intra cerebral activity of antibiotics remains difficult to evaluate because of the ethical obstacles which block such evaluations

[Characteristics of emphysematous pyelonephritis: about four observations]

Emphysematous pyelonephritis is a severe infection which necessitates a management that is both medical and surgical. Early systematic antibiotic therapy is required. Percutaneous drainage is now the first urological approach in most cases. It should not however delay, if necessary, an eventual nephrectomy. We report our experience during 15 years in four women