Late relapse of imported Plasmodium ovale malaria: a case report

We report the first case of an imported Plasmodium ovale relapse in a Tunisian man who developed malaria three years after leaving sub- Saharan Africa. A 29-year-old Tunisian man consulted in September 2011 because of a fever, myalgia, and headache that had begun eight days earlier and persisted despite treatment with oral antibiotics. On questioning, the patient stated that he had resided three years ago for six months in Ivory Coast, where he acquired malaria. He was treated with artemether-lumefantrine. The patient said he had no recent travel to any other malaria-endemic area and had not received a blood transfusion. A first microscopy of peripheral blood smears was negative for malaria parasites. The diagnosis was established 17 days after onset of symptoms. A repeat microscopic examination of blood smears confirmed the presence of Plasmodium ovale with a parasitemia lower than 0.1%. The patient was treated with artemether-lumefantrine, followed by primaquine. This case emphasizes the possibility of relapse of some plasmodial species. It highlights the importance of repeating microscopic examination of blood when the diagnosis of malaria is suspected

[Evolution of the prevalence of intestinal parasitosis in the region of Tunis from 1996 at 2012]

Background: The prevalence of intestinal parasitosis is very different according to countries. Therefore, it is always interesting to update the data in Tunisia to better direct control measures

Aim: The objectives of this survey were to estimate the prevalence of intestinal parasitosis in the region of Tunis, to study their evolution and to establish various combinations of intestinal protozoa

Methods: This is a retrospective study carried out over a period of 17 years from 1996 at 2012 and which involved 20033 individuals. Each subject had one or more stool examination which included a direct microscopic examination and a concentration by modified Ritchie technique

Results: The prevalence of intestinal parasitosis was 12.55%. Entamoeba histolytica/dispar and Giardia intestinalis accounted respectively a prevalence of 0.51% and 1.48%. Hymenolepis nana was the most predominant helminth with a prevalence rate of 0.53%, followed by Enterobius vermicularis [0.21%]. Two cases of Hookworms and seven cases of Strongyloides stercoralis were diagnosed. Polyparasitism concerned 16.59% of infected individuals. Significant combinations occured mainly for amoeba in particular Entamoeba histolytica/dispar and Entamoeba coli [r=0.232]

Conclusion: Our study confirms the decrease of the prevalence of giardiasis and amebiasis, whereas helminthiases with direct transmission remain frequent

[Contribution of polymerase chain reaction for detection of malaria in Tunisia]

Background: In Tunisia, detection of Plasmodium in asymptomatic individuals from endemic countries is a critical measure in national program of malaria eradication. The screening is based on microscopic examination of thick and thin blood smears. However, the performance of this diagnosis is closely related to the experience of biologist and the parasitaemia

Aim: The objective of this study was to evaluate the contribution of the PCR in the screening of malaria

Methods: This prospective study involved 260 students from malaria endemic areas who were screened for malaria between september 2011 and june 2013. Each subject had a blood sample which was examined for malaria by microscopy and nested multiplex PCR

Results: PCR detected the presence of Plasmodium in 13 blood samples [5%]. While microscopy was positive only in nine cases [3.5%]. The discordances involved five negative samples at microscopy and which were positive in PCR and a negative sample in PCR which was positive at microscopy. A mixed infection with Plasmodium falciparum and Plasmodium malariae was identified by PCR. For this case, microscopy diagnosed only Plasmodium falciparum specie

Conclusion: PCR is more efficient than microscopy in detecting low parasitaemia ; particularly observed in asymptomatic subjects. This technique allows to reduce asymptomatic carriage of Plasmodium and reduce the risk of a resumption of transmission of malaria in our country

High risk areas for echinococcosis-hydatidosis in Tunisia

The study was conducted in order to identify high risk areas for hydatidosis in Tunisia witch would be eligible for a Hydatidosis control program initiation. The most recent epidemiological investigation on surgical incidence of hydatidosis was used to classify governorates according to their incidence rate. A [global hydatidosis risk score] was calculated for each governorate, combining some parameters related to the hygiene conditions of the population, the literacy rate, the canine density and livestock census. Spearman correlation coefficient was used to compare scores and surgical incidences. Mapping analysis has been conducted. The surgical incidence rate of hydatidosis classifies each governorate regarding occurrence of human cases. The global hydatidosis risk score, by governorate, pointed out the most exposed areas to the disease. The mapping analysis showed a good agreement between the incidence rate of the disease and the global hydatidosis risk score and made it possible to identify the population of the center and the west of the country as a most exposed population for the diseases. In order to have a chance for implementation, hydatidosis control program should target the three jointed governorates of Kasserine, Siliana and Kef, which have the highest incidence rates and the worst scores

Visceral leishmaniasis in north african countries

Leishmaniasis are worldwide vector-borne diseases due to protozoan flagellates of the genus Leishmania [L.], transmitted by Phlebotomine sandflies to human and mammalians. These affections are endemic in tropical and temperate-climate regions where over 350 millions of people are at risk. The clinical spectrum of leishmaniasis is wide, including asymptomatic infection and 3 main clinical forms: visceral leishmaniasis [VL], potentially fatal when untreated; cutaneous leishmaniasis, usually benign; and mucosal leishmaniasis, a conversely severe mutilating disease[2,3]. Visceral leishmaniasis is caused by L, donovani complex, including L. donovani in the Indian subcontinent and Eastern Africa, and L. infantum in the Mediterranean area, Middle East and Latin America[2,4]. These species are able to spread to internal organs, primarily the liver then the spleen, the bone marrow and the lymph nodes[2,3]. Over 90% of VL cases ensue in the Indian subcontinent and East Africa, and are due to L. donovani with the predominant anthroponotic way of transmission[2]. In the Mediterranean basin, as well in the Middle East, China and South America, VL is caused by the zoonotic species L. infantum[5,6] In North African [NA] countries, VL has been described since the beginning of the 20[th] century. The first case was described in 1904 by Laveran and Cathoire in a child from La Goulette, Tunisia[4]. Since the eighties, there is a clear tendency towards increase with a large-scale spread of emerging cases as observed in several areas of the world[7,9]. Currently, VL is emergent and represents a significant health problem in Algeria, Morocco and Tunisia because of the case-fatality rate, estimated between 5 and 8% [even in treated patients], and regarding the economic burden concerning the cost of treatment and hospitalization[10]. In the present review, the authors updated the epidemiological situation of VL in Morroco, Algeria, Tunisia, Lybia and Egypt. Clinical presentation of the disease and the current strategy for diagnosis and treatment were summarized and discussed

Difficulty in dating primary infections by Toxoplasma Gondii in pregnant women in Tunisia

In Tunisia, serological diagnosis of toxoplasmosis in pregnant women is generally ordered on the first prenatal consultation. As primary tools, IgG and IgM tests are done. Subsequent serological testing is performed to date infection in case of IgM positivity. IgG avidity measurement was done in 156 sera with IgM. The kit [Toxo Avidite] from SFRI was used. This commercial assay permits to rule out an infection acquired in the last 12 months in case of avidity index [AI]>0.6 and to suspect a recent infection acquired in the last 3 months in case of AI<0.3. 57.1% of pregnant women had an AI>0.6; 17.9% an AI<0.3 and 25% an intermediate AI. The high and middle IgG titles were frequently associated with an AI>0.6 whereas low titles were generally associated with an AI<0.6 [p<0.01] and particularly an IA<0.3. If an AI>0.6 is an indicator against primary infection during pregnancy and an AI<0.3 permits to order amniotic sampling for PCR, intermediate avidity dols not permit to conclude mainly because a great proportion of pregnant women do not lave their first prenatal consultation befoe the second trimester of pregnancy. In these cases search for IgA and follow up samples can be useful. To facilitate serological interpretation, the antibody status of pregnant women should be obtained in Tunisia, before or early in pregnancy.

[Contribution of direct agglutination test [DAT] in the diagnosis of visceral Leishmaniasis in Tunisia]

Direct agglutination test [DAT] is a simple and economical technique for visceral leishmaniasis diagnosis. An evaluation, held in Tunisia with 41 confirmed visceral leishmaniasis cases and 58 negative controls, showed a sensitivity of 95,1% and a specificity of 96,5%. These results were highly correlated with those of ELISA and fluorescent antibody test. The use of DAT in our country will be very relevant, mainly in district hospitals, where others classical tests are not available. It will also be useful during sero-epidemiological studies on both human and canine visceral leishmaniasis