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

Medically assisted reproduction and viral infections

During the past ten years Assisted Reproduction has been facing a new demand from patients requiring ART [Assisted Reproductive Techniques]: couples at risk of partner to partner, and mother to child transmission of viral infections, mainly Human immunodeficiency virus [HIV], hepatitis B virus [HBV] and hepatitis C virus [HCV]. The desire to have children is not easy to realize for serodiscordant couples, if we consider that, in order to avoid HIV virus transmission, it is necessary to use the condom in vaginal contacts. On the other hand infertile discordant HCV couples need to be included in protocols of controlled assisted reproduction procedures to avoid any risk of HCV transmission to the partner. In this paper, we review current literature about assisted reproductive techniques [ART] recommendations and results in the context of Human immunodeficiency virus [HIV], hepatitis B virus [HBV] and hepatitis C virus [HCV]

Cocci gram positive infection: regain registry

The Gram positive coccus infections were always preoccupying. In Tunisia, the epidemiological, clinics, therapeutic data concerning these infections remain insufficient. The main objective of this national epidemiological investigation achieved in 13 hospital units in Tunisia is to identify the criteria of choice of antibiotherapy and the profile of patients hospitalized for an infection to Gram positive cocci. This study included 450 patients with an average of 45.35 +/- 21.23 years of which 299 [66.4%] of men and 316 [70.2%] hospitalized in care unit. Two hundred fifty eight patients [62.2%] had one or several medical antecedents, and 145 [32.2%] one or several surgical antecedents. The diabetes [18%] and the chronic renal insufficiency [13.2%] were the two most frequent comorbidities. Signs of gravity to the admission were noted at least 14% of the patients and about 20% of the patients had presented a severe sepsis or a septic shock. The staphylococci [65.4%] were the most frequently the Gram positive cocci isolated follow-up by the streptococci [24.7%]. The resistance of the Gram positive cocci to glycopeptides concerned only one stump cf negative coagulase staphylococcus. Staphylococcus aureus is more frequently responsible for infections of skin and the soft cloths, bone and joint infections and severe sepsis. The rate of success clinic is more elevated in the infectious illness services [84.2% vs 55.3% p<0.0001], whereas mortality is more elevated the services of resuscitation [19.3% vs 3% p<0.0001]. The factors of bad prognosis are age>60 years, in the septic shock, the arterial hypotension to the admission, a score of Glasgow<8 to the admission and an infection to Staphylococcus aureus

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

118 cases of orogenital tuberculosis in the south of Tunisia

The authors had for aim to study the epidemiological, clinical, therapeutic, and evolving features of urogenital tuberculosis [UGT] in the south of Tunisia. 118 patients presenting with UGT were retrospectively studied from January 1982 to December 2007 in South and Central Tunisia. The diagnosis of UGT was confirmed in all cases by clinical, biological, radiological, and/or histological data. 81 male and 37 female patients [mean age 38 years] were included. The most common presentation was storage lower urinary tract symptoms [57.6%]. General signs were observed in 25.4% of cases. The diagnosis of UGT was proven by bacteriological evidence [49.2%], positive bladder biopsy [12.7%], and pathological analysis of a surgical exeresis piece [68.6%]. The treatment was anti-bacillary chemotherapy for all patients, associated to a surgical excision [70.3%], reconstructive procedures [18.6%], and/or endoscopic manoeuvres [13.6%]. 80% of patients were regularly followed up for an average of 6 years. Favourable evolution was observed in 85.3% of cases. UGT remains a current severe disease because of the multiple risks that can result, especially for the renal function

[Cytomegalovirus retinitis: clinical and therapeutic aspects]

CYTOMEGALOVIRUS [CMV] is a frequent infection, which is usually asymptomatic. It is a significant pathogen in terminal acquired immunodeficiency syndrome [AIDS] patients causing major opportunistic events. Retrospective study of 5 AIDS patients with CMV retinitis treated between 1990 and 2001 in the department of ophthalmology in Sfax Hospital centre was conducted to determine clinical and therapeutic featuring, and efficacy of intraveinous and intravitreal ganciclovir to control retinitis in AIDS patients. The results showed that retinitis was controlled in 4 cases and visual acuity improved within three weeks. Serious ocular complications were encountered in 1 case. Concomitant tritherapy was used in 3 cases. In 1 case we noted necrotizing retinitis at the periphery enlarging centrifugally and progressing to the fovea. In immunocompromised patients, Ganciclovir may offer good alternative to control CMV retinitis. Fortunately, with the use of highly active antiretroviral therapy very few patients have disease related to CMV

[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

[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

Meningitis revealing pancreatic carcinoma

Meningeal carcinomatosis is an uncommon metastatic complication of systemic solid tumors. The diagnosis is based on the presence of malignant cells in the cerebrospinal fluid. The sensibility of cerebrospinal fluid testing in detecting the neoplastic cells improves when repeating lumbar punctures. Magnetic resonance imaging could help in establishing the diagnosis. The prognosis of carcinomatous meningitis is poor, especially when the primitive neoplasm is initially unknown. We report the case of a patient presenting with sudden bilateral visual decrease, headaches, and vomiting. Signs of meningeal irritation were found. Cerebrospinal fluid analysis showed malignant cells consistent with an adenocarcinoma. Abdominal echography and MRI concluded in a nodule of the cephalic portion of the pancreas. Carcinomatous meningitis rarely complicates pancreatic cancers

Polyneuretic paraparesis revealing and intramedullary ependymoma

Spinal tumors are rare; intramedullary tumors are uncommon among these lesions, and occur in only 10% of cases in adults. Ependymoma is the most frequent histological type [40-60%]. We report the case of a 22-year-old girl, presenting with local back pain, ascendant paresthesia, a progressive flask paraparesis, and a vesical globe. The clinical examination concluded in a mild motor weakness with areflexia of both patellar and Achilles tendons. The diagnosis of intramedullary tumor was made on MRI. The radiological and the macroscopic aspects evoked an ependymoma; the diagnosis was histologically confirmed after surgery [myxopapillary ependymoma] with a favorable evolution

[Infections and diabetes complications degenerative]

We present a retrospective study of 195 diabetic patients how were hospitalized during the year 2002 and who had an evolution of the role of the different degenerative complications in the occurrence of different infections. The most common bacterial infections encountered were in the urinary tract [n =21], the soft tissue [n[degree] 21] and the bronchopulmonary tract [n =12]. In the soft issue infections, the foot was concerned in 40% of the cases. Urinary tract injections were more common in women [p<0.05]. The frequency of urinary tract infections, septicemia, and bronchopulmonary tract injections was not significantly linked to the existence of degenerative complications, exception the case of the .foot infections that were more frequent in patients with arterial or neuropathic disease of the lower e-extremities

[Tuberculomas intrasellaires: about 2 cases]

Sellar tuberculomas are extremely rare. Their diagnosis is difficult because other intrasellar lesions may have the same clinical and radiological appearance. We report two cases, in which the diagnosis was made on the basis of clinical, paraclinical and therapeutic arguments. The first observation is a 42-year-old unmarried woman who presented with central diabetes insipidus and secondary amenorrhoea. Magnetic resonance imaging [MRI] revealed a nodular thickening of the pituitary stalk, an increased size of the pituitary gland and a loss of the posterior pituitary hyperintensity signal at T1. The tubercular origin of these lesions was deducted from the presence of tubercle Bacillus in the bronchial fluid, and the favourable evolution after anti tubercular treatment. The second observation is a 29-year-old woman with secondary amenorrhoea at the 12th month of treatment for tubercular pleuropulmonary lesions and meningitis confirmed by the presence of Tubercle Bacillus in the cerebrospinal fluid. The MRI revealed a multinodular expansive processus that encircled the pituitary stalk and extended to the infuncibular and hypothalamic regions. These nodules regressed with continuation of the same antitubercular treatment