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

[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

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

[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

[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

[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

Erysipele apres traitement du cancer du sein

study of the epidemiological, clinical and evolutive characteristics of the erysipelas of patients treated for breast cancer. Between February 93 and December 9920 patients among 700 [2.85%] treated for breast cancer in the radiotherapy department of sfax have presented an erysipelas. All of these patients had undergone a chirurgical treatment containing an axillary lymph node dissection with radiotherapy in 95% and adjuvant chemotherapy in 80% of cases. the medium delay between the appearance of the erysipelas and the end of treatment was 23 months. The preferential localization was the homolateral upper limb to the treated breast [95%]. The immediate evolution was favourable in 85% after antibiotherapy. Recurrence of erysipelas was seen in 20% in cases. Erysipelas after treatment of breast cancer is known but rarely reported. The secondary lymphedema of the upper limb is the major favouring factor. Appearance of erysipelas among women treated for brest cancer is frequent, his recurrent character must always lead to antibiotic prophylaxis