[Antibiotic therapy for diabetic foot infections]

Foot infections in patients with diabetes cause substantial morbidity and may lead to amputation. Diabetic foot infections require attention to local and systemic issues and coordinated multidisciplinary management. Aerobic gram-positive cocci, especially S. aureus, are the predominant pathogens. Patients with chronic wounds or who have recently received antibiotics may also be infected with gram-negative or anaerobic pathogens. Wound infections must be clinically diagnosed on the basis of local signs and symptoms of inflammation. Specimens appropriately obtained must be sent for culture prior to starting empirical antibiotic therapy. Tissue specimens obtained by biopsy, ulcer curettage, or drainage are preferred. Infections should be categorized by their severity to determine the degree of risk and the urgency of management. Empirical antibiotic therapy is selected on the basis of the severity and the likelihood of etiological agents. Therapy aimed solely at aerobic gram-positive cocci may be sufficient for mild-to-moderate infections in patients who have not recently received antibiotic. Definitive therapy should be based on the susceptibility data and the clinical response to the empirical regiment. Severe and some moderate infections require pareteral therapy, at least initially. Highly oral bioavailable antibiotics can be used in most mild and moderate infections. Antibiotic therapy should be continued until there is evidence that the infection has resolved but not necessarily until a wound has healed. Surgical evaluation is needed for infections accompanied by a deep abscess, extensive bone or joint involvement, substantial necrosis or gangrene, or necrotizing fasciitis

[Six cases of actinomycosis]

Actinomycosis is a rare granulomatosis infection caused by anaerobic bacteria; Actinomyces. There are many locations of actinomycosis and they can simulate an inflammatory or malignant process or pyogenic infection. We report 6 cases of actinomycosis. The diagnosis was confirmed by an anatomopathologic exam. The evolution was marked by an improvement after prolonged antibiotic treatment. This study shows the difficulties in the diagnosis of actinomycosis and the importance of systematic histopathological examination

[First four cases of acute meningitis due to Toscana virus on monastir region]

Toscana virus [TOSV] has been identified as an important cause of acute meningitis in Italy where it was isolated for the first time. Currently, it is one of the major viral pathgens involved in acute meningitis in Mediterranean countries. We describe four cases of acute meningitis caused by TOSV concerning patients hospitalized in the department of infectious diseases, Fattouma Bourguiba university hospital, Monastir [Tunisia]. The demographic data, the clinical and laboratory features and the evolution were reviewed. All patients were male, living in coastal region. They were hospitalized in summer period. The mean age was 26 years. The diagnosis was suspected in the presence of fever and acute meningitis syndrome. Lumbar puncture showed clear cerebrospinal fluid [CSF] containing normal glucose and predominant lymphocyte. This diagnosis was confirmed by detection of anti-TOSV IgM in blood and CSF. The outcome was favorable in all cases. No specific treatment was administered. The mean follow-up was nine months

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

Intestinal strongyloidiasis rebelled at albendazole in immunocompetent patient: a case report

Interest of ivermectine in Strongyloides stercoralis infection rebelled at a treatment by albendazole. We report an intestinal infection case of Strongyloides stercoralis in 60-year-old immunocompetent women. The diagnosis of Strongyloides stercoralis was suspected on clinical parameters and performed by parasitologic analysis of feces. The outcome was defavourable under treatment by albendazole. Although, clinical and laboratory findings resolved after ivermectine therapy. Ivermectine is the main treatment in intestinal strongyloldiasis rebelled at treatment by albendazol

consultation of anonymous and free tracking of the HIV: attitudes and perception of the risk by the consultants

The infection by human immunodeficiency virus [HIV] is a worldwide public health problem. A Voluntary Anonymous Counseling and Screening Consultation [VASC] give the opportunity to inform high-risk population about the disease transmission its severity and especially the main prevention ways. Our study aims the description of the profile, attitudes and risk perception of consultants in Monastir University Hospital. We performed a descriptive study with a total of 172 consultants who used the services of the VASC during a period of three years [2006-2008]. Information's were gathered from an auto-questionnaire assessing infection risks. Consultant's means age was 26.8 +/- 7.5 years with a female predominance [sex ratio=0.67]. Two patients out of three did not exceed the primary school level and the 3/4 were single. Unprotected sex with multiple partners was the main consultation reason for 84% of patients and 96% knew that HIV is a severe infection. Regarding the practices, 38% had never used condoms and half [562%] had presented past episodes of sexually transmitted infections. According to our study, it is clear that the knowledge of consultants were satisfactory. However efforts should be made to address risk behaviours and attitudes toward infection

Facial cellulitis as a complication of a periradicular abscess due to Gemella morbillorum

Gemella morbillorum is a facultatively anaerobic Gram-positive coccus which forms part of the normal flora of the oro-pharynx, the upper respiratory and gastrointestinal tracts. It rarely causes human infection, more often in immunocompromised hosts. We report a case of periradicular abscess due to Gemella morbillorum occurring in a young immunocompetent adult and review previous reports of infections due to Gemella morbillorum in the literature

Adverse drug reactions: Monastir pharmacovigilance experience

Adverse drug reactions are frequent and may be potentially life threatening. The aim of our study was to evaluate epidemiological, clinical and chronological characteristics of adverse drug reactions and to identify implicated dugs. We involved in our retrospective study all suspected adverse drug reactions notified to the Pharmacovigilance Unit of Monastir during 45 months [2004-2007]. Imputability was established according to Begaud's method et al. Two hundred and seventy seven events thought to be adverse reactions to drugs were notified to our unit. One hundred and fifty seven [56.6%] were judged as being related to drugs. Patients were 77 men and 80 women. [Median: 39 years]. Most frequent adverse drug reactions were skin eruptions [n=111], liver injury [n=16] and pseudo parkinson syndrome [n=13]. Other adverse effects were anaphylactic symptoms, haematological reactions and tendinits. Skin eruptions were mainly induced by betalactam agents [35% of cases] and other anti infectious agents [30%]. Skin eruptions were the most notified adverse drug effects and antibiotics were the most implicated agents

[Antimicrobial susceptibilities of emterobacteriaceae isolated from urinary tract infections in the area of Monastir]

The aim of this study is to determinate the local epidemiology of urinary tract infections in the university hospital of Monastir and to evaluate antimicrobial susceptibility of most incriminated Enterobacteriaceae strains since 2002 to 2005. Identification of strains was based on conventional bacteriological features. Susceptibility to antibiotics was studied according to the Antibiogram Committee of the French Microbiology Society recommendations. In total, 8505 Enterobacteriaceae strains were isolated including Escherichia coli [76%] followed by Klebsiella spp. [10.5%] and Proteus mirabilis [4%]. For E. coli and P. mirabilis, resistances rates were respectively 61% and 71% to amoxicillin, 46.4% and 45.5% to the combination amoxicillin-clavulanic acid, and 39.6% and 26% to cotrimoxazole. Strains of Klebsiella spp. were resistant to cefotaxim and amoxicillin + clavulanic acid in respectively 42% and 20% of cases. Finally, from 2002 to 2005, a significant increase in Enterobacteriaceae resistance was observed for ofloxacin, from 11.9% to 17.6% and ciprofloxacin, from 9.1% to 14.5%. The emergence of antimicrobial resistance justifies that empiric treatment of urinary tract infections should be revised regularly

[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

[Breast tuberculosis: study of 15 cases]

Mammary tuberculosis is a rare disease especially seen in underdeveloped countries. Describe the epidemiological, clinical parameters of mastitis tuberculosis and determinate the interest of imagery and histology in diagnosis. Fifteen cases of tuberculous mastitis diagnosed at the Infectious Diseases and Gynaecology departments of F. Bourguiba hospital during the period from January 1988 to March 2006. The mean age of our patients was 29.2 years [21 - 56 years]. History of tuberculosis was found in 33.3% of the cases. Sixty percent presented with fever and 73.4% complained of skin abscess. We noted symptoms of tuberculosis impregnation in 53.3% of cases. The fine needle aspiration achieved for all patients was negative in 14 cases and brought back the caesium in the other. The diagnosis has been made, for all our patients, after histological study when we found typical tuberculosis lesions on pieces of tumorectomy or biopsy. All patients had an anti-tuberculosis medical treatment. The median duration of treatment was 10 months [9 -18 months]. Although tuberculosis of breast is extremely rare, it should be kept in mind particularly in undeveloped countries. In front of symptoms evoking tuberculosis, biopsies must be done to eliminate an eventual cancer

[Primary purulent pericarditis due to staphylococcus aureus septicemia]

Purulent pericarditis was rarely primitive and commonly it was the spread from a contiguous focus of infection within the chest. We describe a case of a primitive purulent pericarditis due to Staphylococcus aureus septicaemia. GA, 21 years old men, admitted for chest pain and fever due to a Staphylococcus aureus septicemia. Iterative echocardiography showed a discreet clear circumferential pericardial effusion rapidly growing becoming shady and appearance of a right atrium thrombi. Transoesophageal echocardiography showed no valvular abnormalities and confirm the right atrium thrombi attached to the atrial septum. The septic syndrome persist despite suitable antibiotic therapy and the patient presented a shortness of breath due to a pulmonary embolism over an anticoagulation therapy. Later pericardial effusion become important and impressive. The surgical drainage of a purulent fluid was performed. The further course was favourable and the patient was discharged after 5 weeks without signs of ongoing infection or pericarditis. Nine month later, he was asymptomatic and trans-thoracic echocardiography showed no pericardial effusion or sign of constrictive pericarditis

[Drug rash with eosinophilia and systemic cymptoms [DRESS syndrome] associated with sulfasalazine and human herpesvirus 6 infection successfully treated with steroid therapy]

We report a case of a 30-year-old man who developed a generalized erythematous skin eruption, fever, lymphadenopathy, hepatic cytolysis and eosinophilia probably due to sulfasalazine. Indirect immunofluorescence assay for Human herpesvirus-6 [HHV-6] was positive, supporting recent HHV-6 infection. The patient was successfully treated with dexamethasone. The case is reported with a review of the literature. DRESS syndrome mechanisms and management are also discussed