Determinants of consultation, diagnosis and treatment delays among new smear-positive pulmonary tuberculosis patients in Morocco: a cross-sectional study.

We conducted a cross-sectional survey in 2012 in 12 selected provinces and prefectures in Morocco to determine consultation delay (patient delay), diagnosis delay and treatment delay (health system delays), and factors relating to these delays. The sample included 250 eligible and consenting newly diagnosed smearpositive pulmonary tuberculosis patients who were interviewed at the time of their registration within Diagnosis of Tuberculosis and Respiratory Diseases Reference Centers (CDTMR) or Integrated Health Centers (CSI) using a pretested and structured questionnaire. The median total delay was 46 days [inter-quartile interval (IQI) = 29-84 days]. Patient delay (median = 20; IQI = 8-47 days) was higher than health system delay (median=15; IIQ = 7-35 days). Being illiterate, thinking symptoms will disappear by themselves; having financial constraints and feeling fear of diagnosis or social isolation were associated with patient delay. Consulting first in the private sector or having 3 or more consultations before diagnosis was associated with health system delay.

Determinants of consultation, diagnosis and treatment delays among new smear-positive pulmonary tuberculosis patients in Morocco: a cross-sectional study

We conducted a cross-sectional survey in 2012 in 12 selected provinces and prefectures in Morocco to determine consultation delay [patient delay], diagnosis delay and treatment delay [health system delays], and factors relating to these delays. The sample included 250 eligible and consenting newly diagnosed smear-positive pulmonary tuberculosis patients who were interviewed at the time of their registration within Diagnosis of Tuberculosis and Respiratory Diseases Reference Centers [CDTMR] or Integrated Health Centers [CSI] using a pretested and structured questionnaire. The median total delay was 46 days [inter-quartile interval [IQI]= 29-84 days]. Patient delay [median = 20; IQI = 8-47 days] was higher than health system delay [median-15; IIQ = 7-35 days]. Being illiterate, thinking symptoms will disappear by themselves; having financial constraints and feeling fear of diagnosis or social isolation were associated with patient delay. Consulting first in the private sector or having 3 or more consultations before diagnosis was associated with health system delay

Nous avons conduit en 2012 une étude transversale dans une sélection de 12 provinces/préfectures au Maroc pour déterminer les délais de consultation [délai patient], de diagnostic et de mise sous traitement [délai système de santé]chez les nouveaux cas de tuberculose pulmonaire à microscopie positive et les facteurs en relation avec ces délais. L’échantillon comprenait 250 patients, éligibles et consentants, qui ont été interviewés lors de leur enregistrement aux Centres de Diagnostic de la Tuberculose et des Maladies Respiratoires [CDTMR] ou aux Centres de Santé Intégrés [CSI], en utilisant un questionnaire structuré et prétesté. Le délai total médian est de 46 jours [intervalle interquartile [IIQ]: 29-84 jours]. Le délai patient [médiane : 20 jours ; IIQ : 8-47] est supérieur au délai système de santé [médiane : 15 jours ; IIQ : 7-35]. Etre analphabète, croire à la disparition spontanée des symptômes, avoir des contraintes économiques ou peur du diagnostic et de l’isolement social sont associés au délai patient. Consulter en premier dans le secteur privé ou faire trois consultations au moins avant le diagnostic sont associés au délai système de santé

Preparedness and health risks associated with Moulay Abdellah Amghar moussem, Morocco, 2009-2010.

The objective of this study was to describe the risks and human health outcomes associated with attendance at the Moulay Abdellah Amghar moussem (a pre-planned mass gathering attracting more than 360 000 participants) for the purposes of public health prevention, planning, preparedness and response. We performed an environmental health risk assessment and retrospectively reviewed local health centre records before, during and after the event. In addition, standardized interviews with key stakeholders were performed to qualitatively evaluate local public health preparedness and response capacities. During the event, average daily health centre visits increased 5-fold. The sex ratio of health-care visits changed significantly from an average of 1.8:1 female:male visits per day to 1.2:1. The proportion of injuries varied from an average of 3.7% pre- and post-event to 14.8% (P < 0.01) during the event. A significant increase in digestive diseases was also observed during the event. Recommendations include increasing accessibility to free sanitation and hygiene facilities and improving health communications concerning hand washing and food and water safety.

Rapid screening and diagnosis of tuberculosis: a real challenge for the mycobacteriologist.

Tuberculosis (TB) is an infectious, devastating and contagious disease, which infects third of the global population worldwide with high rates of incidence in the developing countries, where the health care providers face a serious problem and a real challenge during their clinical practice for controlling and preventing the transmission of this illness. Indeed the first step of control is the correct diagnosis and the initiation of the drug treatment regimen at the early stage of infection, which mandate the rapidity of screening and the accuracy of laboratory testing. In this paper we aim to highlight the different actual techniques, regarding the rapid screening and diagnosis of tuberculosis.

Mycobacterial species as case-study of comparative genome analysis.

The genus Mycobacterium represents more than 120 species including important pathogens of human and cause major public health problems and illnesses. Further, with more than 100 genome sequences from this genus, comparative genome analysis can provide new insights for better understanding the evolutionary events of these species and improving drugs, vaccines, and diagnostics tools for controlling Mycobacterial diseases. In this present study we aim to outline a comparative genome analysis of fourteen Mycobacterial genomes: M. avium subsp. paratuberculosis K­10, M. bovis AF2122/97, M. bovis BCG str. Pasteur 1173P2, M. leprae Br4923, M. marinum M, M. sp. KMS, M. sp. MCS, M. tuberculosis CDC1551, M. tuberculosis F11, M. tuberculosis H37Ra, M. tuberculosis H37Rv, M. tuberculosis KZN 1435 , M. ulcerans Agy99,and M. vanbaalenii PYR­1, For this purpose a comparison has been done based on their length of genomes, GC content, number of genes in different data bases (Genbank, Refseq, and Prodigal). The BLAST matrix of these genomes has been figured to give a lot of information about the similarity between species in a simple scheme. As a result of multiple genome analysis, the pan and core genome have been defined for twelve Mycobacterial species. We have also introduced the genome atlas of the reference strain M. tuberculosis H37Rv which can give a good overview of this genome. And for examining the phylogenetic relationships among these bacteria, a phylogenic tree has been constructed from 16S rRNA gene for tuberculosis and non tuberculosis Mycobacteria to understand the evolutionary events of these species.

Seroprevalence of hepatitis B and C among barbers and their clients in the Rabat region of Morocco.

A cross-sectional seroepidemiological study was conducted in the Rabat-Salé-Zemmour-Zaër region of Morocco in 2007 among 267 barbers and 529 clients, all men with no history of hepatitis B (HBV) vaccination. The overall prevalence of HBV seropositivity was 28.1% in barbers and 25.1% in clients; 1.9% and 1.7% respectively had active HBV (HBsAg positive). Risk factors for HBV included older age, low educational level, urban living, being married, history of transfusion, lack of current heterosexual relationship and liver-associated symptoms. Observations showed that HBV seropositivity was lower in clean barbershops and those using alum as an antispetic. The rate of PCR-confirmed hepatitis C virus (HCV) was only 1.1% and 1.3% in barbers and clients respectively, and was associated with increased age, drug use, history of surgery and symptoms of liver disease. Less than 1% of barbers were aware of HBV or HCV as causative agents of liver disease or jaundice.

Seroprevalence of hepatitis B and C among barbers and their clients in the Rabat region of Morocco

A cross-sectional seroepidemiological study was conducted in the Rabat-Sale-Zemmour-Zaer region of Morocco in 2007 among 267 barbers and 529 clients, all men with no history of hepatitis B [HBV] vaccination. The overall prevalence of HBV seropositivity was 28.1% in barbers and 25.1% in clients; 1.9% and 1.7% respectively had active HBV [HBsAg positive]. Risk factors for HBV included older age, low educational level, urban living, being married, history of transfusion, lack of current heterosexual relationship and liver-associated symptoms. Observations showed that HBV seropositivity was lower in clean barbershops and those using alum as an antispetic. The rate of PCR-confirmed hepatitis C virus [HCV] was only 1.1% and 1.3% in barbers and clients respectively, and was associated with increased age, drug use, history of surgery and symptoms of liver disease. Less than 1% of barbers were aware of HBV or HCV as causative agents of liver disease or jaundice

Molecular characterisation of rifampicin-resistant Mycobacterium tuberculosis strains from Morocco.

Mutations in the rpoB gene associated with rifampicin (RMP) resistance were studied in 47 RMP-resistant and 147 RMP-susceptible clinical strains of Mycobacterium tuberculosis from Morocco using probe-based assay and DNA sequencing. RMP-resistant mutations were identified in 85% of RMP-resistant isolates. No mutations were observed among the 147 RMP-susceptible strains. Sequence analysis identified 10 alleles, including two deletions not previously reported. Nucleotide changes at codons 531, 526 and 516 were the most prominent, accounting for 74.4% of our RMP-resistant strains. These results demonstrate that resistance genotyping at these codons would be a good marker for the rapid detection of RMP resistance.

[Urethral discharge in Morocco: prevalence of microorganisms and susceptibility of gonococcos]. / Les ecoulements urétraux au Maroc: prévalence des germes et sensibilité du gonocoque.

We studied 422 patients with urethral discharge recruited from 4 sentinel sites in Morocco to determine sociodemographic characteristics, history of STI infection, infecting organism and antibiotic susceptibility of Neisseria gonorrhoeae. The mean age of the sample was 28 years (range 16-67 years), and most were single, had multiple sex partners without taking protective measures and came from all social backgrounds; 59.9% had a history of a previous STI. The majority (87%) of the infections were the acute form. By polymerase chain reaction of urine samples of 399 patients, 41.6% had N. gonorrhoeae infection, 6.3% Chlamidia trachomatis and 10.8% both organisms; in 41.4% no organism was identified. N. gonorrhoeae was strongly susceptible to ciprofloxacin.

[Urethral discharge in Morocco: prevalence of microorganisms and susceptibility of gonococcos]

We studied 422 patients with urethral discharge recruited from 4 sentinel sites in Morocco to determine sociodemographic characteristics, history of STI infection, infecting organism and antibiotic susceptibility of Neisseria gonorrhoeae. The mean age of the sample was 28 years [range 16-67 years], and most were single, had multiple sex partners without taking protective measures and came from all social backgrounds; 59.9% had a history of a previous STI. The majority [87%] of the infections were the acute form. By polymerase chain reaction of urine samples of 399 patients, 41.6% had N. gonorrhoeae infection, 6.3% Chlamidia trachomatis and 10.8% both organisms; in 41.4% no organism was identified. N. gonorrhoeae was strongly susceptible to ciprofloxacin

The leader sequence of the Escherichia coli lysC gene is involved in the regulation of LysC synthesis.

In Escherichia coli and Bacillus subtilis, long leader sequences are found upstream of the lysC coding sequences which encode lysine-sensitive aspartokinase. Highly conserved regions exist between these sequences. Mutations leading to constitutive expression of the E. coli lysC gene have been localised within these conserved regions, indicating that they participate in the lysine-mediated repression mechanism of lysC expression.

Regulation of the xcp secretion pathway by multiple quorum-sensing modulons in Pseudomonas aeruginosa.

The virulence of the opportunistic pathogen Pseudomonas aeruginosa is largely dependent upon the extracellular production of a number of secreted proteins with toxic or degradative activities. The synthesis of several exoenzymes is controlled in a cell-density-dependent manner by two interlinked quorum-sensing systems. Their secretion across the outer membrane occurs through the Xcp translocation machinery. The xcp locus located at 40 min on the chromosome consists of two divergently transcribed operons, namely xcpPQ and xcpR to xcpZ. In this study, transcriptional fusions were constructed between the xcpP and xcpR genes and the lacZ reporter. Transcriptional activation of the xcpP and xcpR genes in P. aeruginosa is growth-phase dependent and the lasR-lasI autoinduction system is required for this control. In the heterologous host Escherichia coli, the lasR gene product, together with its cognate autoinducer N-(3-oxododecanoyl)-L-homoserine lactone (OdDHL), activates both the xcpP-lacZ and the xcpR-lacZ gene fusion. The second P. aeruginosa quorum-sensing modulon rhIR-rhII (vsmR-vsmI) is also involved in the control of the xcp genes. Expression of the lacZ fusions is strongly reduced in PANO67, a pleiotropic mutant defective in the production of N-acyl-homoserine lactones responsible for the activation of RhIR. Furthermore, introduction of the lasR mutation in PANO67 results in additional diminution of xcpR transcription, indicating that the two systems can regulate their target genes independently. These data demonstrate that expression of the xcp secretion system depends on a complex regulatory network involving cell-cell signalling which controls production and secretion of virulence-associated factors.

Xcp-mediated protein secretion in Pseudomonas aeruginosa: identification of two additional genes and evidence for regulation of xcp gene expression.

In Pseudomonas aeruginosa, several exoproteins synthesized with a signal sequence (elastase, lipase, phospholipases, alkaline phosphatase and exotoxin A) are secreted by a two-step mechanism. They first cross the inner membrane in a signal sequence-dependent way, and are further translocated across the outer membrane in a second step requiring secretion functions encoded by several xcp genes. Ten xcp genes have already been characterized (Bally et al., 1992a). In this study, two additional xcp genes, xcpP and xcpQ, are described. They are located in the 40 min region of the chromosome where they probably define an operon, divergent from the xcpR-Z operon previously characterized in this region. These two genes encode two proteins, XcpP and XcpQ, similar to PulC and PulD of the pul system of Klebsiella oxytoca. Moreover, the two divergent operons share a common regulation which is growth-phase dependent.

Protein secretion in Pseudomonas aeruginosa: characterization of seven xcp genes and processing of secretory apparatus components by prepilin peptidase.

The xcp genes are required for the secretion of most extracellular proteins by Pseudomonas aeruginosa. The products of these genes are essential for the transport of exoproteins across the outer membrane after they have reached the periplasm via a signal sequence-dependent pathway. To date, analysis of three xcp genes has suggested the conservation of this secretion pathway in many Gram-negative bacteria. Furthermore, the xcpA gene was shown to be identical to pilD, which encodes a peptidase involved in the processing of fimbrial (pili) subunits, suggesting a connection between pili biogenesis and protein secretion. Here the nucleotide sequences of seven other xcp genes, designated xcpR to -X, are presented. The N-termini of four of the encoded Xcp proteins display similarity to the N-termini of type IV pili, suggesting that XcpA is involved in the processing of these Xcp proteins. This could indeed be demonstrated in vivo. Furthermore, two other proteins, XcpR and XcpS, show similarity to the PilB and PilC proteins required for fimbriae assembly. Since XcpR and PilB display a canonical nucleotide-binding site, ATP hydrolysis may provide energy for both systems.

Protein secretion in gram-negative bacteria: transport across the outer membrane involves common mechanisms in different bacteria.

The xcp genes are required for protein secretion by Pseudomonas aeruginosa. They are involved in the second step of the process, i.e. the translocation across the outer membrane, after the exoproteins have reached the periplasm in a signal peptide dependent fashion. The nucleotide sequence of a 2.5 kb DNA fragment containing xcp genes showed at least two complete open reading frames, potentially encoding proteins with molecular weights of 41 and 19 kd. Products with these apparent molecular weights were identified after expression of the DNA fragment in vitro and in vivo. Subcloning and complementation experiments showed that both proteins are required for secretion. The two products are located in the inner membrane and share highly significant homologies with the PulL and PulM proteins which are required for the specific secretion of pullulanase in Klebsiella pneumoniae. These homologies reveal the existence of a common mechanism for protein secretion in Pseudomonas aeruginosa and Klebsiella pneumoniae.